距骨骨折的手术治疗

The Operative Therapy for the Fracture of Talus

目的探讨距骨骨折的特点、类型、手术方法及影响疗效的相关因素。方法1998年12月至2004年12月，共治疗距骨骨折39例，根据Hawkins分型方法，Ⅰ型骨折5例，Ⅱ型骨折25例，Ⅲ型骨折9例。Ⅰ型骨折采用松质骨拉力螺钉内固定；Ⅱ、Ⅲ型骨折行急诊手术，其中Ⅱ型骨折采用前外侧切口暴露，解剖复位，2枚松质骨拉力螺钉交叉内固定；Ⅲ型骨折采用踝前内侧切口暴露，解剖复位，松质骨拉力螺钉内固定，伴有内踝骨折时同时复位内固定，并以自体髂骨块跨骨折线嵌入植骨。术后短腿管形石膏外固定12～24周，X线片示骨折线模糊后拆石膏行不负重下踝关节活动，骨折线消失后恢复伤前活动。结果除2例失访外，37例获得随访。随访时间1．5～6年，平均3年。根据Hawkins疗效标准判定，优12例（32．4％），良17例（45．9％），可6例（16．2％），差2例（5．4％），优良率为78．4％。结论距骨骨折虽然并发症多且后果严重，但是通过急诊手术、解剖复位、有效内固定、自体髂骨块嵌入植骨、局部封闭、理疗等综合治疗，可降低病残率。

Objective To study the characteristics, the classifications, the operative and the factors influencing therapeutic effectiveness of fracture of talus. Methods 39 cases of talar fracture from December 1998 to December 2004 were treated. According to Hawkins classification, there were type Ⅰ in 5 cases which were treated with lag screws fixation, type Ⅱ in 25 cases and type Ⅲ in 9 cases which were all treated with emergence operation, while type Ⅱ were exposured by anterior-lateral incision, with anatomic reduction and fixation with two lag screws intercrossed, type Ⅲ were exposured by anterior-internal incision with anatomic reduction and fixation with lag screws, if the fracture of malleolus medialis accompany, it was redueted and fixated at the same time and autograft with ilium striding fracrure line. After operation, all were immobilized with short leg cast for 12~24 weeks, the ankle began exercise without burden when the fraerure line was illegible in X ray and exercised as normal when that was disappeared. Results 2 cases were withdrawed, others were followed up 1.5 to 6 years （mean 3 years）. According to the Hawkins criteria, 12 cases were rated as excellent（32.4%）, 17 cases good （45.9%）, 6 cases fair（16.2%）, 2 cases poor（5.4% ）, the rate of excellent and good was 78.4%. Conclusion The complications of fracture of talus are common and severe, but treated with comprehensive threpy of emergency operation, anatomic reduction, effective fixation, autograft with ilium, region block and physical therapy, it can be reduced.