经内外踝截骨入路可吸收螺钉或可吸收棒内固定修复距骨骨折:15例随访

Internal or external malleolus osteotomy using absorbable screw or absorbable stick for talar fracture: follow-up in 15 cases

背景:距骨骨折后复位的严格要求及距骨血供的易受损伤是治疗距骨骨折的两个难点,或者称为两个平衡点。一方面距骨骨折要求比较精确的复位,另一方面又要很好的保护距骨血供。目的:探讨经内外踝截骨入路可吸收螺钉或可吸收棒内固定修复距骨移位骨折的方法及临床疗效。方法:2008年6月至2011年6月治疗距骨骨折16例,经内外踝截骨入路,切开复位可吸收螺钉或可吸收棒固定距骨,外踝复位后采用钢板再固定,内踝复位后采用空心螺钉或钢板再固定,术中特别注意保护血供。内侧切口自内踝尖的前缘约到舟状骨结节,在胫骨前肌和胫骨后肌之间,注意保护大隐静脉,注意切开的三角韧带区仍有残留的距骨体的血供,应精心保护;在清理碎骨片时要细心,电钻及螺钉打入固定距骨时不可太偏下靠近距下关节,以免损伤跗骨窦血管网及跗管动脉。根据患者主诉,踝关节外形、功能以及X射线片、CT扫描来评价临床效果,疗效评价采用Hawkings评分标准。结果与结论:15例患者获得随访,随访时间25-36个月。疗效评价采用Hawkings评分标准,优8例(53%),良5例(33%),可1例(7%),差1例(7%),优良率为86%。提示采用经内外踝截骨入路可吸收螺钉或可吸收棒内固定修复距骨移位骨折是疗效比较确切可靠的方法。

BACKGROUND： Strict requirement of the reduction after talar fracture and susceptibility to blood supply dysfunction in talus are two main problems for the treatment of talar fracture, which is also called two balance points. On one hand, talar fracture needs precise reduction; one the other hand, blood supply in the talus should be protected. OBJECTIVE： To explore therapeutic effect of internal or external malleolus osteotomy using absorbable screw or absorbable stick for talar fracture. METHODS： From June 2008 to June 2011, 16 patients of talar fracture were treated with internal or external malleolus osteotomy. The talus was fixed using absorbable screw or absorbable stick, and refixed with steel plate or cannulated screws after reduction of internal or external malleolus. The blood supply should be protected during the operation. Internal incision was derived from the anterior border of medial malleolus to tubercle of scaphoid bone, between tibialis anterior and tibialis posterior muscle, avoiding the great saphenous vein. The rest blood supply of the talus which resided in the triangular ligament area should also be protected. When cleaning bone fragments, the drills and screws should not be close to subtalar joint, avoiding injury in the vascular network of tarsal sinus and the artery in tarsal tunnel. Based on the patient＇s chief complains, clinical efficacy was evaluated through detections of ankle joint appearance and function, X-ray and CT scanning. The therapeutic effect was assessed with Hawkings scoring system. RESULTS AND CONCLUSION： The involved 15 patients were followed up for 25-36 months. According to the modified Hawkings, 8 patients （53%） were rated as excellent, 5 patients （33%） good, 1 （7%） fair and 1 （7%） poor, the total rate of being excellent and good was 86%. Operation through approach of internal or external malleolus osteotomy using absorbable screw or absorbable stick is a good method for treatment of talar fracture.