Hawkins Ⅲ、Ⅳ型距骨骨折手术治疗探讨

Treatment of Hawkins type Ⅲ and Ⅳ fractures of talus

目的评价采用经胫骨内踝截骨入路加空心螺钉固定治疗Ⅲ型、Ⅳ型距骨骨折临床疗效。方法 2004年9月～2010年9月,对采用经胫骨内踝截骨向下翻转入路加空心螺钉固定治疗的18例Hawkins Ⅲ、Ⅳ型距骨骨折患者的临床治疗进行回顾性分析。结果按Hawkins分类法:Ⅲ型骨折12例,Ⅳ型骨折6例。其中17例解剖复位或近似解剖复位,1例复位不满意。距骨缺血坏死3例,其中缺血坏死颈部1例,体部2例;Ⅲ型发生1例,Ⅳ型发生2例。其它病例未并发创伤性关节炎,踝关节功能恢复均较满意。结论经胫骨内踝截骨入路加空心螺钉固定治疗Hawkins Ⅲ、Ⅳ型距骨骨折具有手术视野显露清楚,方法简便,固定牢靠,缩短了骨折愈合的时间,降低了距骨缺血坏死的发生率,并发症少的优点。是治疗Hawkins Ⅲ、Ⅳ型距骨骨折的理想方法。

Objective To discuss the efficacy of the therapy for the talus fracture of Hawkins type Ⅲ and Ⅳ by using the tibial malleolus osteotomy hollow screw fixation. Methods From Sept.2004 to Sept.2010,the clinical data of 18 patients with the talus fracture of Hawkins type Ⅲ and Ⅳ who were treated with ankle turning down into the hollow screw fixation were retrospectively analyzed. Results According to the classification of Hawkins,there were 12 cases of Hawkins Ⅲ,and 6 cases of Hawkins Ⅳ.Seventeen cases got the anatomical reposition or proximate anatomical reposition,and the reposition of 1 case was not satisfied.In 3 cases of talus ischemia and necrosis（including 1 case of type Ⅲ and 2 cases of type Ⅳ）,ischemia and necrosis occurred at the talus neck in 2 cases and at the talus body in one case.No tramatic arthritis occurred in the rest patients.The recovery of ankle joint function was satisfactory. Conclusion The procedure of ankle turning down into the hollow screw fixation for the talus fracture of Hawkins type Ⅲ and Ⅳ can provide a clear operative field.The method is simple with stable fixation,can shorten the healing time,reduce the incidence of ischemic necrosis of the talus,and has less complications.