距骨颈骨折的治疗分析

Treatment of talar neck fractures

目的研究距骨颈骨折的治疗。方法1988年10月-2004年6月，按改良Hawkins法对66例距骨颈骨折患者分型：Ⅰ型14例，行石膏外固定；Ⅱ型34例，行手法复位石膏外固定、切开复位内固定或关节融合术；Ⅲ型16例，行切开复位内固定或关节融合术；Ⅳ型2例，行切开复位内固定或关节融合术。其中陈旧性骨折4例。结果平均随访6．28年，采用Hawkins评分进行评估，优（29％）19例（Ⅰ型13例，Ⅱ型5例，Ⅲ型1例）；良（26％）17例（Ⅰ型1例，Ⅱ型12例，Ⅲ型4例）；可（27％）18例（Ⅰ型11例，Ⅱ型6例，Ⅳ型1例）；差（18％）12例（I型6例，Ⅱ型5例，Ⅳ型1例）。距骨缺血性坏死25例（38％），踝及距下关节炎分别为20例（30％）和26例（39％）。结论距骨颈Ⅰ型和Ⅱ型骨折宜石膏外固定，Ⅲ型骨折应切开复位内固定，Ⅳ型和陈旧性骨折宜采用关节融合术。

Objective To study the methods treating talar neck fractures. Methods From October 1988 to June 2004, 66 patients with talar neck fractures were treated with different methods. According to modified Hawkins classification, there were 14 patients with type Ⅰ fractures treated with plaster external fixation, 34 with type Ⅱ treated with manipulative reduction plus plaster external fixation, 16 with type Ⅲ treated with open reduction and internal fixation or joint fusion and 2 with type Ⅳ treated with open re- duction and internal fixation or joint fusion. There were four patients with old fractures. Results All patients were followed up for mean 6.28 years and clinical outcomes evaluated according to Hawkins scoring system, which showed that 19 patients （29%） were graded excellent （including 13 type I fractures, 5 type Ⅰ and 1 type Ⅲ）, 17 good （including 1 type Ⅰ fracture, 12 type Ⅱ and 4 type Ⅲ）, 18 fair （including 11 type Ⅱ fractures, 6 type Ⅲ and 1 type Ⅳ） and 12 poor （including 6 type Ⅱ, 5 type Ⅲ and 1 type Ⅳ）. There occurred osteonecrosis in 25 patients （38%）, traumatic arthritis of ankle joint in 20 （30%） and that of subtalar joint in 26 （39%）. Conclusions For type Ⅰ mad Ⅱ fractures, plaster external fixation should be the choice of treatment. While open reduction and internal fixation should be done for type m talar neck fractures and joint fusion for type Ⅳ and old fractures.