距骨颈骨折的急诊微创手术治疗

Emergent microsurgery for the talus neck fractures

目的:评价应用空心拉力螺钉或可吸收螺钉急诊微创内固定治疗距骨颈骨折的可行性和疗效。方法:对2000年1月至2008年12月收治并获得随访的27例距骨颈骨折进行回顾性分析。骨折按Hawkins分型:Ⅰ型5例,Ⅱ型18例,Ⅲ型4例,全部在C臂X线机监视下行急诊闭合复位或有限切开复位辅助空心拉力螺钉或可吸收螺钉内固定治疗,术后定期复查,条件允许时去除石膏进行功能训练。结果:随访6个月～2年,平均12.6个月。采用Hawkins评分:优11例(Ⅰ型4例、Ⅱ型7例),良9例(Ⅰ型1例、Ⅱ型8例),中5例(Ⅱ型3例、Ⅲ型2例),差2例(均为Ⅲ型),优良率为74%。结论:急诊行微创手术治疗是一种有效的适宜于距骨颈骨折的治疗方法,该法既能实现骨折复位和稳固的固定作用,又避免了对骨折周围血供的进一步破坏,可降低距骨缺血性坏死的发生。

Objective：To evaluate the feasibility and results of emergent microsurgery with cannulated cancellus bone screw or absorbable screw for talus neck fractures.Methods：27 cases of talus neck fractures were treated in our department from January 2000 to december 2008.All of them were followed up and retrospectively reviewed.Based on Hawkins classification：there were 5 cases of type 1,18 cases of type Ⅱ and 4 cases of type Ⅲ.All cases were treated with manipulative reduction and internal fixation with cannulated cancellus bone screws or absorbable screws.After follow-up,the plaster was moved away when necessary.Results：The follow-up ranged from 0.5 to 2 years（means 12.6 months）.According to Hawkins evaluation system,11 cases were assessed as excellent,9 as good,5 as fair and 2 as poor.The good-to-excellent rate was 74%.Conclusion：The emergent microsurgery for the talus neck fractures is a safe and effective way.Good stability is obtained and the aggressive impairment of blood supply around the fracture is avoided.This technique can decrease talus ischemic osteonecrosis.