青少年距骨外侧突骨折——一种易于漏诊的踝关节损伤

Lateral process fracture of talus in adolescents easlly mlssed ankle injury

目的探讨青少年距骨外侧突骨折的临床特点、诊治方案及临床效果。方法2011年3月至2013年10月间我科共收治12例距骨外侧突骨折患儿，其中男9例、女3例，年龄8～13岁，左侧8例、右侧4例；致伤原因为5例高处坠落伤、2例立定跳远时受伤、3例下楼梯时摔伤及2例骑自行车摔伤；1例合并有跟骨骨折、t例合并腓骨瑶端骨骺损伤，均移位不显著；受伤至就诊时间2h至2个月。12例患儿中，我科首诊7例、4例伤后外院诊断为踝关节扭伤后4～6d转来我科，1例伤后2个月来我科就诊。按照Hawkim骨折分型原则，I型3例、Ⅲ型9例，无一例Ⅱ型骨折。治疗方案为所有类型骨折中，移位不超过2mm者行非手术治疗、移位大者行切开复位光滑克氏针固定，而漏诊2个月的给予对症治疗。结果本组病例共12例，其中我科首诊7例、外院漏诊5例，临床漏诊率为42％；4例为首诊医生阅片疏忽漏诊、1例拍片体位不当漏诊。所有患儿均获得随访，平均随访时间18个月；随访终了时的躁关节x线片提示无一例距骨坏死、骨折不愈合及畸形愈合发生。根据美国足踝外科（AOFAS）协会后足评分系统评估疗效。其中优10例、良1例、可1例。优良率92％。评分为可的是漏诊2个月的患儿。结论儿童距骨外侧突骨折临床易于漏诊，必须依靠仔细体格检查及必要的影像学检查方可避免f同时应根据移位程度及骨折类型选择治疗方案，可取得较佳临床疗效。

Objective To explore the clinical characteristics, treatment and outcome of lateral process fracture of talus in adolescelats, Methods From March 2011 to October 2013, 12 children （8 boys, 3 girls） with lateral process fractulre of talus were recruited. The injuries were at left （n = 8） and right （n = 4） sides. The age range at the time of injury was 8-13 years. The causes of injury were falls （n = 5）, standing long-jump （n = 2）, fall down stairs （n = 3） and bicycle accident （n = 2）. And the concomitant injuries included nondlsplaced ealcaneus fractures （n = 1） and distal fibula epiphyis injury （n = 1）. Their presentation time was 2 hours to 2 months after injury. All cases were classified by the Hawkins fracture system, Treatments included immobilization plus non-bearing weight for 4 weeks for nondisplaced fractures or open reduction and fixation for displaced fractures. Results Among them, 7 cases were initially diagnosed at our department and 5 cases had a missed diagnosis at other hospitals. The missed diagnosis rate was 42%. During an average follow-up period of 18 months, there was no radiographic evidence of avascular necrosis of talus, nonunion or malunion. According to the American Orthopedic Foot Ankle Society （AOFAS） score, the outcomes were excellent （n= 10）, good （n= 1） and fair （n= 1）. Coneluslons The lateral process of talus fracture is frequently missed. A definite diagnosis is dependent upon careful physical and imaging examinations. And optimal therapy is selected by displacement extent and fracture type.