距骨颈骨折和距骨体脱位的解剖与临床研究

Anatomy and clinical researth on fracture of neck of talus and dislocation of talus

目的探讨吻合血管股前外侧髂骨皮瓣修复距骨颈骨折和距骨体脱位的临床效果。方法于2005年1月～2008年1月收治8例距骨颈骨折、距骨体脱位伴皮肤缺损患者,采用吻合血管的股前外侧髂骨骨皮瓣,行距骨颈骨折复位,脱位距骨体钢板内固定,然后带血供髂骨瓣植入,将皮瓣修复踝前部皮肤缺损。结果8例均获满意效果。8例患者中创面一期愈合7例,延迟愈合1例。将带血供髂骨瓣植骨距骨颈部骨折端,达到重建距骨体血供,促进了距骨颈骨折愈合,并修复踝部创面,从而防止距骨体缺血性坏死。经2个月至3年的随访,距骨颈骨折愈合好,未发现距骨体缺血坏死,踝关节活动功能正常。结论对距骨颈骨折、距骨体脱位,以往多采用单纯距下关节或胫距关节融合,或邻近骨瓣转位治疗,但对伴有皮肤缺损的患者一次修复缺乏修复材料。作者自行设计吻合血管的股前外侧髂骨瓣,可重建距骨体血运,促进距骨颈骨折愈合,防止距骨体坏死,同时修复踝部创面,是距骨颈骨折、距骨脱位伴皮肤缺损修复的新方法。

Objective To assess the clinical outcome of repairing talar neck fracture and talar body dislocation with vascular anastomosis and anterolateral femoral iliac skin flap. Methods From January of 2005 to January of 2008, 8 patients with talar neck fracture and talar body dislocation accompanied with maleolar skin defects were treated with vascular anastomosis and anterolateral femoral il iac skin flap. The talar neck fracture was repositioned and the talar body dislocation was fixed internally with steel plates. Then the iliac flap with blood supply was grafted to repair the anterior maleolar skin defect. Results The clinical outcome was satisfactory in all 8 patients. Of the 8 patients, wound surface healed well in the first stage in 7 patients, and delayed in the remaining one patient. Grafting the iliac flap with blood supply to the fractured end of talar neck helps reconstruct blood supply to the talar body, thus facilitating the healing of the talar neck fracture and repairing the ma- leolar wound surface, and preventing ischemic necrosis of the talar body. 3-to 36-month follow-ups showed that the talar neck fracture healed well without any ischemic necrosis of the talar body, and the maleolar joint function was normal. Conclusion Talar neck fracture and talar body dislocation used to be treated with simple subtalar joint fusion or tibiotalar joint fusion, or with adjacent bone flap transposition therapy. For patients with talar neck fracture and talar body dislocation accompanied with skin defects,one go repair is difficult because of lacking repair materials. We designed an approaching of using vascular anastomosis and anterolateral femoral iliac skin flap to reconstruct blood supply to the talar body, which facilitates the healing of talar neck fracture, preventing the talar body from necrosing, and repairing the maleolar skin wound at the same time. This is a new technique for repairing talar neck fracture and talar body dislocation accompanied with skin defects.