微小切口空心拉力螺钉内固定治疗距骨颈骨折的疗效分析

Effect Analysis on Internal Fixation of Cannulated Bone Screw for Talus Neck Fracture

目的总结微小切口空心拉力螺钉内固定治疗距骨颈骨折的临床疗效。方法回顾性分析2008年1月～2013年11月我院诊治的28例距骨颈骨折患者临床资料。骨折按Hawkins分型：Ⅰ型2例，Ⅱ型22例，Ⅲ型3例，Ⅳ型1例。均在C臂X线机透视下行急诊闭合复位（7例）或开放微小切口切开复位（21例），空心拉力螺钉内固定治疗，术后定期复查、随访。结果本组患者手术时间平均60（50～80）min，术中出血约30ml，无一例发生伤口感染、皮肤软组织坏死等围手术期并发症。28例患者均获随访，平均18（6～36）个月。本组骨折愈合时间10～14个月，平均（12．0±0．5）月。根据Hawkins标准评估疗效：优23例，良4例，差1例，优良率为96．4％。1例HawkinⅣ型患者发生距骨体明显硬化坏死。结论微小切口空心拉力螺钉内固定是有效治疗距骨颈骨折的方法之一，可以明显减少距骨缺血性坏死并发症的发生。

Objective To evaluate the curative effect of internal fixation of cannulated bone screw for displaced talus neck fracture via minimally incision. Methods The clinical data of 28 patients with displaced talar neck fracture were analyzed retrospectively, including 2 cases of type Ⅰ , 22 cases of type Ⅱ, 3 cases of type Ⅲ and 1 case of type Ⅳ according to Hawkins fracture classification. After closed reduction （7 cases）or limited open reduction （21 cases） , the internal fixation of cannulated lag screw was performed in all 28 cases. Results The operative duration was 50 to 80 ml with an average of 60 ml, and the intra-operative blood loss was 30 ml. No preoperative complications such as wound infection or soft tissue necrosis were found. All 28 cases were followed up for 6 to 36 months with an average of 18 months. According to Hawkins clinical criteria, the results were revealed excellent in 23 cases, good in 4 cases, false in 1 case, and the fineness rate was 96.4%. The cirrhosis and necrosis of talus body was found in one case with type Ⅳ. Conclusion The internal fixation of cannulated bone screw via minimally incision is one of effective treatment for displaced talus neck fracture with less post-operative complication of ischemic osteonecrosis.