双切口接骨板内固定治疗距骨颈粉碎性骨折的临床效果

Open reduction and plate fixation with dual incisions for comminuted talar neck fractures

背景:距骨颈骨折是距骨骨折中最常见的类型,采用切开复位螺钉内固定是经典的手术方式,但总体疗效仍不尽人意,尤其是采用单切口时,内翻畸形愈合率较高,且对于粉碎性骨折,螺钉固定效果也不佳。双切口是目前临床推崇的手术入路,结合接骨板固定,可获得良好的疗效。目的:探讨双切口接骨板内固定治疗距骨颈粉碎性骨折的手术技巧及疗效。方法:2010年5月至2011年5月,我院共收治13例闭合距骨颈粉碎性骨折患者。根据Hawkins分型:Ⅱ型8例,Ⅲ型5例。所有患者入院后行常规X线检查及CT扫描以明确骨折类型和粉碎程度,待肿胀消退后择期行双切口接骨板内固定术。术后定期复查X线片,并采用直观模拟量表(VAS)、美国骨科足踝外科协会(AOFAS)踝与后足评分系统及简明健康状况调查表(SF-36)综合评估最终治疗效果,同时记录相关并发症情况。结果:本组11例获得随访,随访时间12～24个月,平均18.7个月。患者术后均无切口感染,边缘和皮瓣坏死及内固定失败等并发症发生。X线结果显示,术后骨折端愈合的时间为8～12周,平均10.4周。末次随访时VAS评分0～5分,平均1.09±1.64分。AOFAS踝与后足评分为72～95分,平均84.55±7.29分。SF-36评分为70～96分,平均85.00±7.84分。未见畸形愈合发生。结论:采用双切口接骨板内固定治疗距骨颈骨折技术要求简单,在获得稳定固定的同时,还可维持距骨颈力线,避免畸形愈合,是治疗距骨颈粉碎性骨折有效的治疗方法。

Background： Talar neck fracture is the most common type of all talar fractures. Open reduction and screw fixation is a classi- cal technique. But the outcome is not quite acceptable, especially with a single incision. The incidence of varus malunion is very high and a rigid fixation may not be obtained by screws in comminuted fractures. So surgeons try to apply dual inci- sions with plate fixation for talar neck fractures and a good clinical outcome has been achieved. Objective： The aim of the present study is to summarize and evaluate the surgical technique and clinical outcome of open re- duction and plate fixation with dual incisions for comminuted talar neck fractures. Methods： Thirteen patients with closed comminuted talar neck fractures were treated between May 2010 and May 2011. Ac- cording to Hawkins classification, there were 8 cases of type II and 5 cases of type III. All cases were evaluated carefully with X-ray and CT scan preoperatively to define the type and degree of fracture. Open reduction and plate fixation with dual incisions was performed until the swelling of soft tissue was resolved. X-ray films were taken in the regular follow-up. Func- tional evaluation was carried out according to Visual Analogue Scale （VAS）, the ankle and hind-foot score of American Or- thopaedic Foot and Ankle Society （AOFAS） and SF-36. Complications were also recorded. Results： Eleven patients were followed up with a mean duration of 18.7 months （12 to 24 months）. There were no complica- tions of wound infection, skin and flap necrosis or implant failure. X-ray demonstrated the bone union was achieved at an average 10.4 weeks （8 to 12 weeks） postoperatively. The average VAS score was 1.09± 1.64 （0 to 5）, AOFAS ankle and hind-foot score was 84.55±7.29 （72 to 95） and SF-36 score was 85.00±7.84 （70 to 96） at the final follow-up. No obvious malunion occurred. Conclusions： Open reduction and plate fixation with dual incisions is an effective option for comminuted talar neck fractureIt is easy to be operated, meanwhile, it can achieve a stable fixation, restore alignment of talus and avoid varus malunion.