双切口入路微型接骨板内固定治疗距骨颈骨折

Treatment of talus neck fracture with mini plate internal fixation through dual incision approaches

目的：探讨双切口入路微型接骨板内固定治疗距骨颈骨折的临床疗效。方法 ：自2010年8月至2013年2月,采用前内侧加前外侧双切口入路治疗距骨颈骨折18例,其中男10例,女8例;年龄31~66岁,平均38.2岁;左侧8例,右侧10例。根据Hawkins分型：Ⅱ型12例,Ⅲ型6例。所有患者术前常规行X线片及三维CT检查以明确骨折类型和粉碎程度,待肿胀消退后择期行双切口入路微型接骨板内固定术。术后定期复查X线片,并采用视觉模拟评分（VAS）、美国骨科足踝外科协会（AOFAS）踝-后足评分系统对其术后疗效进行评估。结果：16例患者获得随访,失访2例,平均随访时间22.6个月（17~46个月）。术后无切口感染、边缘和皮瓣坏死及内固定失败等并发症发生。1例出现距下关节创伤性关节炎。VAS评分由术前（5.94±1.12）分降为术后末次随访时（1.06±1.06）分（t=27.13,P〈0.05）。末次随访时AOFAS踝与后足评分为（88.75±10.19）分,优11例,良3例,可2例。结论：采用双切口入路微型接骨板内固定治疗距骨颈骨折能获得坚强的内固定,特别是距骨粉碎性骨折,能降低并发症,是治疗距骨颈骨折有效的治疗方法。

Objective：To explore clinical outcomes of talus neck fracture treated with mini plate internal fixation through dual incision approaches. Methods：From August 2010 to February 2013,18 patients with closed talus neck fractures were treated（10 males and 8 females,aged from 31 to 66 years old with an average of 38.2 years old） with mini plate internal fixation through dual incision approaches. According to Hawkins classification,12 cases were typeⅡ and 6 cases were typeⅢ. All cases were evaluated with X ray and 3D CT scan preoperatively to define type and comminuted degree of fractures. Mini plate fixation with dual incision approaches was performed after swelling was resolved. X ray films were taken during following up regularly.Functional evaluation was carried out according to Visual Analogue Scale（VAS）,the ankle and hind foot score of American Orthopedic Foot and Ankle Society（AOFAS）. Complications were also recorded. Results：Sixteen patients were followed up with an average time of 22.6 months（ranged,17 to 46 months）. No wound infection,skin and flap necrosis or implant failure were found. Traumatic arthritis in subtalar joint was found in 1 patient. Preoperative VAS（5.94±1.12） was decreased to postoperative（1.06±1.06）（t=27.13,P0.05）. The average AOFAS score was 88.75±10.19 at the latest following up;and 11 cases obtained excellent results,3 good and 2 moderate. Conclusion：Mini plate fixation with dual incision approaches for talus neck fracture especially for talus neck comminuted fracture,an effective method,could obtain stable fixation,decrease complications.