距骨颈骨折的手术治疗

Surgical treatment of talar neck fractures

目的:探讨手术复位螺钉内固定治疗距骨颈骨折的临床效果。方法:28例距骨颈骨折患者,男20例,女8例;年龄22～72岁,平均38岁。所有骨折按Hawkins法分型,Ⅰ型6例,Ⅱ型18例,Ⅲ型4例。均行切开复位螺钉内固定,其中6例行急诊手术。结果:28例均获随访,时间1～7年,平均2.8年。按Hawkins疗效标准:优14例,良9例,可3例,差2例,优良率为83.2%。术后出现距骨体坏死5例,Ⅱ型骨折3例,Ⅲ型骨折2例,其中2例因距骨体坏死、塌陷或疼痛性关节炎而行踝关节融合术;术后出现单纯踝关节炎3例;距骨下关节炎6例,其中2例合并踝关节炎;无伤口感染和踝关节内侧皮肤坏死。结论:手术复位螺钉内固定治疗距骨颈骨折可取得满意的临床疗效,保护残存血运,解剖复位,稳定内固定可提高治疗效果。

Objective：To explore the clinical effect of talar neck fractures treated by open reduction and internal fixation with screws. Methods：Among 28 cases in the study,20 cases were males and 8 cases were female. The age ranged from 22 to 72 years with an average of 38 years. Based on the Hawkins classification,there were 6 cases of type I,18 of typeⅡand 4 of type Ⅲ. They were treated by open reduction and internal fixation with screws. Results：Twenty-eight cases were followed up for 1 to 7 years（mean 2.8 years）. The evaluation of the results by Hawkins functional rating scale revealed excellent in 14 cases,good in 9 cases,fair in 3 cases and poor in 2 cases. The excellent and good rate were 83.2%. Osteonecrosis occurred in 5 cases with 3 of typeⅡand 2 of typeⅢfractures. Two of 3 cases with talar displacement were found with osteonecrosis or painful arthritis. The subtalar arthritis occurred in 6 cases,3 of which were associated with ankle arthritis. Two cases underwent arthrodesis because of painful arthrit is of the subtalar joint or osteonecrosis of the talar body. Wound infection and anteromedial skin necrosis of the ankle were not found. Conclusion：Treatment of talar neck fractures could obtain satisfactory clinical results through open reduction and internal fixation with screws. Protection of the residual blood supply,anatomically reduction and stable fixation are essential for successful treatment of talar neck fractures.