可吸收螺钉内固定配合血管束植入治疗严重距骨颈骨折8例

Operative treatment of severely displaced talar neck fractures with absorbable lag screw combined with implantation of vascular bundle

目的：探讨严重距骨颈骨折的治疗方法。方法：利用可吸收螺钉对骨折行内固定并行血管束植入术治疗8例严重距骨颈骨折。术后膝下石膏管型固定12周,骨折有明显愈合迹象后,患者每日定时在短石膏靴外进行一定范围内活动。结果：8例均获随访15~30个月,平均18个月,骨愈合时间20~30周。按AOFAS足部评分标准,功能优良率87.5%。术后1例伤口表浅皮肤感染并皮缘部分坏死,为Hawkins型。术后随访无并发距骨体缺血性坏死。结论：应用可吸收拉力螺钉固定配合血管植入术治疗严重距骨颈骨折是一种新手术方法,辅以严格的术后处理可获得良好的临床治疗效果,值得推广使用。

Objective：To study a new kind of operation for severely displaced talar neck fractures. Methods：From 1999 to 2005,8 severe talar neck fractures were treated by internal fixation of absorbable lag screw combined with implantation of vascular bundle. A non-weight-bearing below-knee cast was applied for 12weeks after operation. Once union of the fracture site was apparent, the patient should remain non-weight bearing in Removable short-leg and keep exercise everyday. Results： All the patients received follow-up from 15 to 30 month with an average of 18 months. The fractures healed within 20 to 30 weeks.The excellent and good rate of function was 87.5% according to American Orthopedic Foot and Ankle Society Score （AOFAS）.One case had the complication of superficial infection of wound and skinedge necrosis after operation,which was Hawkins typeⅢ.Late complication included one case of avascular necrosis（AVN）. Conclusion： Treatment of severie talar neck fractures by internal fixation of absorbable lag screw combined with implantation of vascular bundle is an ideal method.