距骨骨折手术治疗临床疗效分析

Clinical Analysis of Talus Fracture with Operative Treatment

目的：探讨距骨骨折经手术治疗后的的临床疗效。方法：手术治疗距骨骨折16例，骨折分型依据Hawkins分型，Ⅰ型2例，Ⅱ型5例，Ⅲ型6例，Ⅳ型3例。Ⅰ型距骨骨折采用透视下闭合复位松质骨拉力螺钉内固定，Ⅱ、Ⅲ、Ⅳ型骨折行切开复位2枚松质骨拉力螺钉交叉内固定治疗，切口采用前外侧或前内侧切口暴露。术后踝关节中立位短腿石膏管形外固定8-12周，拆除石膏行不负重下踝关节活动，X线片示有连续骨痂通过骨折线可负重行日常活动。结果：所有患者术后均获得随访，随访时间6-48个月，平均30.3个月。术后功能评分使用美国足踝协会后足评分系统（AOFAS）评定，优5例，良8例，可2例，差1例，优良率为81.3%。结论：及时早期手术、合理手术方案、骨折解剖复位、距骨血运的保护、坚强有效的内固定、合理植骨、早期踝关节功能锻炼可提高距骨骨折手术后的临床疗效，减少骨折后并发症的发生。

Objective：To explore the clinical efficacy of talus fracture by operative treatment.Method：16 cases of talus fracture with operative treatment, according to Hawkins fracture type classification,Ⅰtype 2 cases,Ⅱtype 5 cases,Ⅲtype 6 cases,Ⅳtype 3 cases.Ⅰtype talus fractures closed reduction and screw fixation under fluoroscopy cancellous lag.TypeⅡ,Ⅲ,Ⅳtype fracture underwent open reduction and two cancellous lag screw fixation cross incision using anterolateral or anteromedial incision.Ankle in neutral position short leg cast tubular external fixator 8-12 weeks postoperative,did not remove the plaster line under load ankle,daily activities were taken after X-ray showed a continuous fracture callus lines.All patients were followed up for 6-48 months,average 30.3 months.Result：All patients were followed up for 6-48 months,average 30.1 months.Acording to AOFAS hindfoot scoring system criteria,there were excellent in 5 cases,good in 8 cases,fair in 2 cases,poor in 1 case,with the good rate of 81.3%.Conclusion：Timely early surgery,reasonable surgical plan,anatomical reduction,protection of the talus blood,strong and effective internal fixation,bone graft reasonable,early functional exercise can improve the clinical efficacy after operatian and reduce complications after fracture happen.