距骨颈骨折治疗方法及疗效分析

Treatment of talar neck fractures and analysis of the curative effect

[目的]探讨距骨颈骨折的治疗方法及疗效。[方法]对2005年6月～2009年10月收治的48例距骨颈骨折患者中获得随访的45例患者进行回顾性分析。根据Hawkins分型,I型7例,Ⅱ型20例,Ⅲ型15例,Ⅳ型3例。I型骨折采用石膏外固定或闭合经皮克氏针固定及石膏固定方法;Ⅱ型骨折行闭合复位克氏针固定或切开复位螺钉固定;Ⅲ型、Ⅳ型骨折行切开复位螺钉内固定术。应用x2检验对手术时机、骨折类型、开放与否、骨折复位情况及是否合并距骨周围骨折因素进行分析,观察这些因素与手术疗效的相关性。[结果]平均随访时间3.6年(2～5年),依据Hawkins评分进行评估,其中优26例,良12例,中5例,差2例,优良率为84%;距骨体缺血坏死9例,II型骨折3例,Ⅲ型骨折4例,Ⅳ型骨折2例。距骨坏死率与骨折的开放性、复位不良及是否合并周围骨折呈正相关性(P<0.05);创伤性关节炎14例(31%),畸形愈合7例(16%),无骨折不愈合病例。[结论]移位的距骨颈骨折应积极行手术治疗,正确的治疗方法可以降低并发症的发生率;骨折后继发距骨缺血性坏死并不影响最终的功能结果。

[Objective]To study the effect of the treatment in talar neck fractures.[Method]Forty-eight cases of talar neck fractures were treated in our department from June 2005 to October 2009.Forty-five cases got followed-up were retrospectively reviewed.Based on the Hawkins classification,there were seven cases of type Ⅰ,twenty cases of type Ⅱ,fifteen of type Ⅲ and three of type Ⅳ.Seven cases of type Ⅰ were treated conservatively with plaster immobilization or closed percutaneous pinning and fixed neutral position plaster.Twenty cases of type Ⅱ were treated with open reduction and screw fixation or closed reduction and Kirschner wires fixation.Fifteen cases of type Ⅲ and 3 cases of type Ⅳ were treated with open reduction and screw fixation.Chi-square test method,timing of surgery,type of fracture,open or not,and whether combined with fractures of the talus fractures factors were analyzed to observe the correlation between these factors and operative outcomes.[Result]All patients were followed up for a mean of 3.6 years（ranged,2-5 years）.According to Hawkins evaluation system,twenty-six cases were assessed as being excellent,twelve cases as good,five cases as fair,and two as poor.Ischemic necrosis of the talus body was found in nine cases,with type II fractures of three cases,type III fracture of four cases,type IV fracture of two cases.Necrosis of the talus had positive relation with the rate of open rate,reset bad and whe ther combined with fractures of the talus（P0.05）.Traumatic arthritis were found in 14 patients（31%）,abnormal healing in 7 patients（16%）,with no cases of nonunion.[Conclusion]Displaced talar neck fractures should be actively treated with surgery,and the correct treatment can reduce the incidence of complications.Avascular necrosis of talus after fracture does not affect the final functional outcome.