经内踝截骨入路中空加压螺钉治疗距骨颈骨折

Operative treatment of talar neck fracture through approach of internal malleolous osteotomy and cannulated compression screw for fixation

目的探讨内踝截骨入路中空加压螺钉治疗距骨颈骨折的疗效。方法采用经内踝截骨入路中空加压螺钉内固定治疗距骨颈骨折35例,术后短腿石膏托外固定,早锻炼晚负重,并根据X线片骨折愈合情况选择下肢负重时间。结果35例均获得随访,时间6个月～5年。根据Hawkins疗效标准及术后并发症情况进行评估:优16例(45.7%),良10例(28.6%),可7例(20.0%),差2例(5.7%),优良率为74.3%。发生局部皮肤坏死4例,伤口感染2例,距骨缺血性坏死5例,创伤性关节炎4例,无畸形愈合及骨折不愈合发生。结论经内踝截骨入路中空加压螺钉内固定治疗距骨颈骨折显露充分,复位方便,固定可靠,疗效优良。

Objective To discuss and analyse the therapeutic effect of talar neck fracture through approach of internal malleolous osteotomy and hallow compression screw tot fixation. Methods 35 patients of talar neck fracture were treated with open reduction and eannulated compression serew fixation through approach of internal malleolous osteotomy. With plaster external fixation,the ankle began functional exercise without burden as soon as possible. Deciding the lower limb weight loading time according to radiographs. Results All were followed up from 6 months to 5 years. According to the Hawkins criteria the results were excellent in 16 cases （45.7%） good in 10 （28.6%）, fair in （20. 0% ） , and poor in 2 （5.7%）, and the rate of excellent and good was 74.3%. There were 4 eases of necrosis of skin,2 wound infection,5 osteochondritis, and 4 traumatic arthritis. No malunion or disunion was found. Conclusions Operative treatment of talar neck fracture through approach of internal malleolus osteotomy provides thorough exposure, reliable reduction, effective internal fixation, satisfacyory therapeutic effect.