外踝截骨骰骨瓣移植在复杂距骨颈骨折中的应用

Treatment of complex talarneck fractures through approach of external malleolus osteotomy with cuboid bone-flap graft

目的观察经外踝截骨骰骨瓣移植治疗复杂距骨颈骨折的疗效。方法 2007年9月至2013年3月采用经外踝低位截骨入路带血管蒂骰骨瓣移植治疗复杂距骨颈骨折脱位患者17例（HawkinsⅢ型14例,Ⅳ型3例）,观察术中骨折暴露复位内固定情况,术后骨折愈合及踝关节功能恢复状况。结果病例均获随访（9个月-4年）,平均2.5年,骨折全部愈合,5例发生距骨缺血性坏死,6例轻度踝及距下关节炎,踝关节功能按照Hawkins标准评定：优9例,良5例,可3例,优良率为82.35%。结论此术式治疗复杂距骨颈骨折脱位,有利于手术显露及操作,可保护骨折处残存血供,重建骨折端血供,能较大程度减少创伤性关节炎及距骨缺血性坏死的发生。

Objective To evaluate the clinical effects in operative treatment of talarneck fractures through approach of external malleolus osteotomy with cuboid bone- flap graft. Methods From september 2007 to march2013,17 patients of complex fracture- dislocation of talarneck（ 14 cases of Hawkins type Ⅲ and 3 of typeⅣ） in ourdepartment were treated by open reduction,internal fixation using low- position external malleolus osteotomy approach and transposition of cuboid bone- flap with the laternal tarsal artery. Exposition of the fracture and surgicaltreatmentof open reductionand internal fixation were reviewed in operation. The clinical effects of bone healing and theankle and subtalar joint functional recovery were analysed after operation. Results All the patients were followed up ranged from 0. 75 to 4 years,average 2. 5 years. No postoperative non- union,the avascularnecrosis of the talus was seen in 5cases（ on radiographies）,traumatic arthritis（ mild）were occurred in 6 cases. According to Hawkins evaluation standards,9 patients obtained excellent results,5 patients good,3fair. The total rate of being excellent and goodwas 82. 35%. Conclusion This operation was a better and reliable method totreat the complex talarneck fractures,which can easy and clearly expose the operative field to facilitate anatomical reduction and stable internal screwfixation. Mostimportantly,it can preserve the residualvessels and rebuild the blood supply of talus. It can effectively decrease the avascular necrosis and traumatic arthritis of the talus.