Acutrak钉治疗距骨颈骨折

Surgical treatment of talar neck fractures with Acutrak screws

目的探讨利用Acutrak钉同定结合不同植骨方式治疗距骨颈骨折的疗效。方法2006年10月至2010年5月应用Acutrak钉内固定治疗22例距骨颈骨折患者，男14例，女8例；年龄17～48岁，平均33．5岁。其中HawkinsI型骨折（4例）采用经皮内固定；Ⅱ型（11例）采用前内侧切口内固定加植自体髂骨；Ⅲ型（7例）采用带血管蒂的腓骨瓣逆行转移加崮定术。Ⅱ、Ⅲ型骨折术后石膏固定骨折至愈合后负重。结果患者术后获2～4年（平均2．8年）随访。术后伤口均一期愈合，距骨骨折均获愈合，无距骨坏死等并发症发生。按Hawkins评分标准评定疗效：优9例，良7例，可4例，差2例，优良率为72．7％。其中踝关节创伤性关节炎2例，距下关节创伤性关节炎3例。结论Acutrak钉渐进式加压螺钉可使骨折固定更加坚固，效果优于空心钉及可吸收钉。采用闭合经皮固定、自体髂骨植骨、带血管蒂的腓骨瓣逆行转移针等方法对不同骨折类型均具有优越性，根据不同的骨折类型选择不同的手术方法可获得较好疗效。

Objective To explore surgical treatment of talar neck fractures with Acutrak screw fixation plus different bone grafts. Methods From October 2006 to May 2010, 22 patients with talar neck fraeture were treated operatively at our hospital. They were 14 men and 8 women, aged from 17 to 48 years （average, 33.5 yeas） . By Hawkins classification, there were 4 cases of type I, 11 cases of type II and 7 cases of type m. All cases received internal fixation with Acutrak screws. The Hawkins type I cases were treated by minimally invasive percutaneous fixation. The type II eases were treated by open reduction ＆ internal fixation （ORIF） through the medial approach plus autologous iliac grafting. The type m cases were treated by ORIF plus reversed transfer of vaseularized fibular flap. Weight-bearing was not allowed for all cases of II and m type until fracture healed under plaster immobilization. Results All patients were followed up for an average of 2.8 years （from 2 to 4 years） . All fractures healed without osteoneerosis or early complications. According to Hawkins criteria, 9 cases were rated as excellent, 7 as good, 4 as fair and 2 as poor, with an excellent to good rate of 72.7%. But 2 eases presented with posttraumatic tibiotalar arthritis and 3 with posttraumatic subtalar arthritis. Conclusions For talar neck fractures, Acutrak screws can provide better fixation than hollow screws and absorbable screws. Different surgical methods, such as closed percutaneous fixation, autologous iliac grafting and reversed transfer of vascularized fibular flap, should be recommended for different types of talar neck fracture.