21例距骨颈骨折的手术治疗分析

Clinical Analysis of Surgical Treatment of 21 Cases with Talus Neck Fracture

目的探讨距骨颈骨折手术治疗的方法、疗效及并发症的防治。方法 2010年3月-2012年5月,对21例距骨颈骨折患者采用切开复位两枚空心螺钉内固定术,总结其手术入路、内固定方法、术后处理及术后疗效评估。结果 21例患者均在术后12～14 d伤口拆线出院,无伤口感染、不愈合或皮肤坏死发生。出院后21例患者中全部获得随访,随访1～3年(平均2年1个月),术后内翻畸形2例,距骨缺血性坏死2例,胫距及距下关节创伤性关节炎3例,骨折延迟愈合1例。3例术后1年行关节融合术。疗效评定采用Hawkins评分:优6例,良8例,中4例,差3例。结论对于距骨颈骨折进行手术解剖复位,正确的切口选择、坚强固定及早期无负重功能锻炼,可明显降低骨折后并发症的发生率。

Objective To study the surgical treatment of talus neck fracture and prevention of complications.Methods Twenty-one cases of talus neck fracture were retrospectively analyzed between 2010 and 2012.The operative approaches,internal fixation methods and postoperative treatments were summarized.Results All cases were discharged from hospital on time with out wound infection,disunion and skin complication.The patients received a follow-up from 1 year to 3 years（mean 2 year and one month）,and the clinical results were excellent in 6 cases,good in 8 cases,common in 4 cases and poor in 3 cases,according to Hawkins standard.Conclusion Operative treatment should be performed actively when anatomic reduction of talus neck fracture was not achieved.Perfect anatomic reduction of the fracture,solid internal fixation and enough period off weight loading were recommended,which could lessen the probability of complications.