距骨颈骨折术中植骨与否的对比分析

The Efficacy of Bone Graft or not to Treat Talus Neck Fracture

目的分析距骨颈骨折手术中植骨与否对其缺血坏死发生率及功能预后的影响。方法回顾性分析我院2006年6月至2012年5月收治的49例距骨颈骨折手术患者距骨骨折坏死率及功能预后情况,其中术中行自体骨移植（A组）25例,Hawkins-Canale分型分别为Ⅱ型8例、Ⅲ型12例、Ⅳ型5例;术中未行植骨术（B组）24例,Hawkins-Canale分型分别为Ⅱ型7例、Ⅲ型13例、Ⅳ型4例;术前经AOFAS评价两组损伤程度无统计学差异,术后按Hawkins标准评价距骨坏死率及功能预后。结果 49例患者随访12~32个月,平均18.7个月,19例出现距骨缺血性坏死（A组6例、B组13例）,距骨缺血坏死率分别为A组24.0%,B组54.2%,其中7例需处理,3例行踝关节融合,2例行距下关节融合,2例行减压植骨;另外12例踝关节、距下关节功能良好,无距骨塌陷及骨性关节炎表现。根据Hawkins足部评分标准,优14例（A组9例）、16例（A组11例）、可12例（A组2例）、差7例（A组2例）;优良率分别为A组80.0%、B组41.7%。结论距骨颈骨折（Hawkins-Canale分型为Ⅱ~Ⅳ型）术中使用自体骨移植内固定明显优于单纯复位内固定,术后距骨颈骨折缺血坏死率明显降低,且患肢功能明显优于未植骨者。

Objective To analyze the effect of chemia necrosis rate and functional outcomes after the bone graft or not intraoperative to treat talus neck fracture.Methods A retrospective analysis from June 2006 to May 2012,49 cases were from bone neck fracture surgery patients from bone fracture necrosis rate Hawkins-Canale points respectively typeⅡ for 8 cases,type Ⅲ for 12 cases,5cases of type Ⅳ;intraoperative do not use bone graft（group B）,24 cases were Hawkeins-Canale points respectively type Ⅱ for 7 cases,type Ⅲ for 13 cases,type Ⅳ for 4 cases.Results 49 patients were followed up for 10-32 months,an average of 18.7 months,19 cases appear avascular necrosis of talus（group A 6patients;group B,13 patients）,is apart from the bone ischemia necrosis rate of 24.0% respectively in group A,and 54.2% in group B with the need to handle 7 cases,3 routine ankle fusion,2 isroutine joint fusion,2 routine decompressionand bone;The other 12 cases from the ankle,under joint function is good,no bonecollapse from osteoarthritis and performance.According to Hawkins foot evaluation criterion,optimal 14 cases（group A 9 cases）,16 cases（A group of 11 cases）,can be in 12 cases（group A 2 cases）,and sent in 7 patients（group A 2 cases）;group A 80.0% rate respectively,B group of 41.7%.Conclusion From the bone ne-ck fractures（Hawkins-Canale points for type Ⅱ~Ⅳ）,the intraoperative using autogeneous bone graft fixation is better than.the pure obvious internal fixation and bone neck fractures from post-operative ischemia necrosis rate reduced significantly,and limb function were not obviously better than the bone.