空心钉结合带筋膜跗外侧血管蒂骰骨骨膜瓣移位治疗距骨颈骨折

Cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery in the treatment of talus neck fractures

目的探讨空心钉结合带筋膜跗外侧血管蒂骰骨骨膜瓣移位治疗距骨颈骨折的手术方法及临床疗效。方法2008年3月至2011年6月，对收治的12例距骨颈骨折采用空心钉结合带筋膜跗外侧血管蒂骰骨骨膜瓣移位治疗。术后非负重功能位外固定12—14周，并根据x线片显示骨折愈合情况确定负重时间。末次随访时根据美国足与踝关节外科协会踝与后足功能评分系统评价术后功能。结果12例术后随访12—48个月，平均24个月。1例出现切口皮缘坏死，经换药处理后愈合。距骨颈骨折均获愈合，愈合时间为16～24周，平均20周。末次随访时AOFAS踝与后足功能评分为55～96分，平均82．5分，其中优4例，良5例，可3例。2例发生距下关节轻度创伤性关节炎，口服消炎镇痛药后疼痛缓解；1例发生距骨体缺血性坏死，X线片显示距骨体骨质硬化，但未塌陷，嘱患者减少负重并定期随访观察。结论应用空心钉结合带筋膜跗外侧血管蒂骰骨骨膜瓣移位治疗距骨颈骨折，能改善距骨体血供，降低距骨缺血性坏死的发生，是有效的治疗手段。

Objective To investigate the surgical techniques and clinical efficacy of cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery in the treatment of talus neck fractures. Methods From March 2008 to June 2011, 12 cases with talus neck fractures were treated with cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery. External fixation in functional position for 12-14 weeks, and the load time was determined by X-ray fracture healing. Functional results were assessed according to AOFAS （ American Orthopaedic Foot and Ankle Society ） score at last follow-up. Results Twelve cases were followed up for an average of 24 months （ 12 to 48 months）. One case of skin flap necrosis healed by dressing. All the fractures healed, and the mean healing time was 20 weeks （ 16 to 24 weeks）. AOFAS ankle and hindfoot mean postoperative score was 82. 5 （ranging from 55 to 96） points. Among them 4 cases were excellent, good in 5 cases, fair in 3 cases. Two cases presented with mild posttraumatic subtalar arthritis and pain relief after oral anti-inflammatory analgesic. One case with avascular necrosis of talus body, and X-ray displayed sclerosis of talus body, but no collapse, and the patient was told to reduce weight and regularly followed up. Condnsion The application of cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery for the treatment of talus neck fractures is an effective treatment, which can improves the blood supply of the talus body and reduces the occurrence of avascular necrosis of the talus.