关节镜微创治疗距骨颈骨折的临床疗效

Analysis of minimal invasive treatment of talar neck fracture under arthroscopic surveillance

目的评价关节镜监视下微创治疗距骨颈骨折的临床疗效。方法回顾性研究2005-2013年于我院住院治疗的距骨颈骨折患者27例,根据治疗方法分为关节镜组和切开复位内固定组。关节镜组常规采用前内侧和前外侧入路,必要时加用距下关节入路;切开复位内固定组均采用相同的前内侧切口。两组术中均达到骨折的解剖复位,终末随访时进行美国足踝外科协会(AOFAS)的踝-后足评分(AHS评分)。结果两组患者术后均无感染刀口不愈合的情况。关节镜组2例患者发生了距骨缺血性坏死(AVN),其中Ⅱ型患者1例、Ⅲ型患者1例,发生率为18.2%;切开复位内固定组4例发生了距骨缺血性坏死,其中Ⅱ型患者3例、Ⅲ型患者1例,发生率为25%(χ2=7.143,P=0.008)。最终随访时,关节镜组AHS评分为(86.3±9.2)分,切开复位内固定组为(78.5±7.8)分,组间差异具有统计学意义(t=1.303,P=0.205)。结论关节镜监视下复位经皮内固定距骨颈骨折创伤小,降低术后距骨缺血性坏死发生率,临床疗效满意,是治疗距骨颈骨折患者的良好选择。

Objective The purposes of the present study were to describe arthroscopic treatment approach of talar neck fracture,and to evaluate the clinical and functional outcomes. Methods 27 cases with talar neck fractures were enrolled from 2005 to 2013 in this retrospective study. These patients were divided into two groups, arthroscopic group, open reduction and internal fixation （ORIF） group. The anterior- medial portal and anterior-lateral portal were used in arthroseopic group. Subtalar joint portal was used as it was needed. The anterior medial incision was made in ORIF group. Anatomical reduction obtained in all of the cases. The final follow-up examination included the clinical outcome and determination of the AHS （ankle-hindfoot scale） score from the American Orthopaedic Foot and Ankle Society （AOFAS）. Results We noted no skin complications. At final follow-up,two patients （18.2%,Type Ⅱ 1 case,Type m 1 case） developed avascular necrosis （AVN） of the talus in arthroscopic group. Four patients （25%, Type Ⅲ 3 cases,Type m 1 case）had AVN in ORIF group （X2 = 7.143,P = 0.008）. The mean AOFAS score of arthroscopic group was （86.3 ± 9.2） and that of ORIF group was （78.5 ± 7.8, t = 1.303,P = 0.205）. Conclusion The clinical outcome of arthroscopic treatment of talar neck fracture was satisfaction. Minimal invasive treatment of talar neck fracture under arthroseopic surveillance could decrease the incidence of AVN, and it is a good alternative in clinical practice.