经内踝截骨入路联合后外侧小切口中空加压螺钉内固定治疗HawkinsⅢ、Ⅳ型距骨骨折

Operative treatment of HawkinsⅢ and Ⅳ talus fracture through approach of malleolus medialis osteotomy plus posterolateral minimally invasive and hollow compression screw fixation

目的探讨经内踝截骨入路联合后外侧小切口中空加压螺钉内固定治疗HawkinsⅢ、Ⅳ型距骨骨折的方法及临床疗效。方法自2008-08—2012-08共诊治距骨骨折23例（骨折按Hawkins分类：Ⅲ型17例,Ⅳ型6例）,均采用内踝截骨联合后外侧小切口中空加压螺钉内固定治疗。末次随访时根据美国足与踝关节外科协会（Americam Orthopaedic Foot and Ankle Society,AOFAS）制定的踝与后足功能评分系统评定术后功能。结果术后2例失访,21例获得随访6-48个月,平均32.6个月。其中19例达到解剖复位或近似解剖复位,2例复位不满意。距骨缺血坏死4例（HawkinsⅢ型骨折发生1例,Ⅳ型骨折发生3例）,发生率为19.05%（4/21）。末次随访时AOFAS踝与后足功能评分为46-98分,平均79.5分;优5例,良9例,可4例,差3例,优良率66.7%。12例发生创伤性关节炎,发生率为59.1%（12/21）。结论采用内踝截骨入路联合后外侧小切口中空加压螺钉内固定治疗HawkinsⅢ、Ⅳ型距骨骨折,手术视野显露清楚,操作简单,固定坚强,降低了距骨缺血坏死及创伤性关节炎的发生率。

Objective To study the method and effects of the operative treatment of the Hawkins Ⅲ and Ⅳ talus fracture through approach of malleolus medialis osteotomy plus posterolateral small incision and hollow compression screw fixation.Methods From August 2008 to August 2012, 23 patients with fractures of the talus were treated in our hospital. By Hawkins classification, 17 cases were type Ⅲ fracture and 6 cases were type Ⅳ fracture. The malleolus medialis osteotomy plus posterolateral small incision and hollow compression screw fixation were used. At last follow-up postoperative function according to the AOFAS（American Orthopaedic Foot and Ankle Society, AOFAS） ankle and hindfoot developed functional scoring system were evaluated. Results Twenty one cases had completed follow-up data, 2 cases were lost, 21 cases were followed up for 6-48 months, mean 32.6 months. Nineteen cases had anatomical or nearly anatomical reduction, two cases unsatisfactory reduction. Avascular necrosis of the talus occurred in 4 cases（type Ⅲ 1 case, type Ⅳ 3 cases）, the rate was 19.05%（4/21）. The average AOFAS score was 79.5. There were 5 cases in excellent results, 9 in good and 4 in fair and 3 in poor. The overall excellent and good rate was 66.7%. Traumatic arthritis occurred in 12 cases and incidence was 59.1%（12/21）.Conclusion Operative treatment of the Hawkins Ⅲ and Ⅳ fracture through approach of malleolus medialis osteotomy plus posterolateral small incision and hollow compression screw fixation could give a clear vision, simple, fixed-strong, and reducing the incidence of ischemic necrosis of the talus traumatic arthritis.