门形钉联合空心钉治疗复杂距骨骨折伴距舟关节脱位

Door Staples Combined wi th Hollow Na ils in Treatment of Complex Tla us Fracture Accompany Tla onavicular Joint Dislocation

目的：探讨空心钉联合门形钉内固定治疗距骨骨折伴距舟关节脱位的方法及可行性。方法：回顾分析自2009年7月～2013年3月收治的7例距骨骨折伴距舟关节脱位患者，其中男2例，女5例，年龄35～68岁，平均52岁；其中距骨颈骨折HawkinsⅣ型3例，距骨体骨折Matti～Weber Ⅲ型4例；受伤原因：车祸伤6例，重物压伤1例；合并第5跖骨基底骨折2例，均为新鲜损伤，在处理合并症后，同时进行骨折切开复位内固定术，手术时间为伤后1小时～7天。结果：本组7例均得到随访，平均随访时间约12个月，仅1例患者出现舟骨、楔骨骨质疏松，术后3个月复查X线片，骨质密度恢复正常。所有患者均无感染、皮缘坏死、骨坏死及慢性踝关节失稳出现。采用美国足踝关节协会（ AOFAS）后足评分系统评价踝关节功能优5例，良1例，可1例，优良率85．7％，术后患侧与健侧肘关节ROM比较差异无明显统计学意义（P＞0．05）。结论：应用空心钉联合门形钉治疗距骨骨折伴距舟关节脱位操作简单，符合生物力学特点，固定牢固可靠，降低了并发症的发生率，是治疗复杂距骨骨折伴距舟关节脱位的理想方法之一。

Objectvi e：To investigate the treatment and feasibility of complex talus fracture accompany talonavicular joint dislocation with Door staples combined with hollow nails .Methods：We retrospectively reviewed 7 Patients who underwent surgery for talus fracture accompany talonavicular joint dislocation from July 2009 to March 2013 , The patients included 2 males and 5 females at a mean age of 52 years（ range 35-68 years）;According to Hawkins classification of talar neck fractures , 3 patients were with type Ⅳ,according to Matti -Weber classification of talar body fractures , 4 patients were with type Ⅲ;6 patients in traffic accident ,and 1 patient was injured by pres-sure.Among them there were 2 patient accompany with the base of the fifth metatarsal;when finish all the Complications ,treated the frac-tures of all cases with open reduction and internal fixation using Door staples combined with hollow nails ,and the early motion were per-formed after operation .Results：Of all,7 patients were followed up for a mean duration of 12 months,which showed fracture union in all patients,just1 patient was found osteoporosis in navicular bone and cone form bone ,which recovered 3 month after.Using the AOFAS an-kle foot score system function show that ,5 cases were excellent ,1 cases good and 1case fair , excellent rate is 85.7%. Conclusion：Door staples combined with hollow nails has advantages of simple operation ,reliable fixation ,coincidence with biomechanical characteristics and reduce the complication and hence is one of ideal methods for treatment of talus fracture accompany talonavicular joint dislocation .