距骨骨折脱位的手术治疗

Operative Treatment of Fracture-Dislocation of the Talus

目的探讨距骨骨折脱位的特点、类型、手术方法及影响疗效的相关因素。方法本组距骨骨折脱位30例，均为男性；年龄18-46岁，平均33．6岁。骨折根据Hawkins分型，I型4例，Ⅱ型20例，Ⅲ型6例。I型距骨骨折采用闭合松质骨拉力螺钉内固定。Ⅱ、Ⅲ型骨折均行急诊手术，采用前外侧或前内侧切口暴露，骨折解剖复位后，以2枚松质骨拉力螺钉交叉内固定；其中Ⅲ型骨折并取自体髂骨块跨骨折线嵌入植骨。术后踝关节中立位短腿石膏管形外固定8-12周，复查x线示骨折线模糊后拆除石膏行不负重下踝关节活动，骨折线消失后可完全负重行日常活动。结果30例均获得随访，随访时间1．5-6年，平均3年。根据美国足踝协会后足评分系统评定，优10例（33．3％），良13例（43．3％），可5例（16．7％），差2例（6．7％），优良率为76．6％。结论距骨骨折脱位虽然并发症多并且后果严重，但是通过急诊手术、骨折解剖复位、尽量保护血运、有效内固定、自体髂骨块跨骨折线嵌入植骨、术后力争早期踝关节功能锻炼，可降低病残率。

Objective To investigate the characteristic, classitication,operative methods and factors effect clinic result of talus fracture-dislocation. Methods 30 cases of talus fracture-dislocation were treated in our hospital,All the patients were male,aged form 18 to 46 years （mean 33. 6 years）,according to Hawkins Fracture classification, there were type I in 4 cases which were treated with lag screws fixation,type II in 20 cases and type ~ in 6 cases underwent emergence operation ,which were exposured by anterolateral or anteromedial incision,with anatomic reduc- tion and fixation with two cross-cancellous bone lag screw fixation,which ~l fracture embedded in bone from the iliac bone block cross-fracture line. After operation,all the ankles were immobilized with short leg cast for 8-12 weeks. The unloading exercise began without burden when the fracrure line was illegible in X ray and louding exercised when fracture line was disappeared. Results 39 patients were followed up for 1.5 to 6 years （mean 3 years）. According to the AOFAS hindfoot scoring system criteria,there are excellent in 10 cases （33.3 %）,good in 13 cases （43.3 %）,fair in 5 cases （16.7%）,poor in 2 cases （6.7%）,with the good rate of 76.6%. Conclusion The complications of frac- ture-dislocation of the talus are common and severe. Emergency surgery,anatomical reduction,profection of the blood supply,effective internal fixation,autogenous iliac bone graft across the fracture line and early postoperative ankle ex- ercise,may be helpful to reduce disability rate and can be reduced.