有限切开内固定治疗距骨骨折的临床分析

Clinical study of minimally invasive internal fixation treatment of talus fracture

目的总结和探讨距骨骨折的治疗方法。方法2008年1月至2014年11月通过C臂x线机下有限切开撬拨复位，空心拉力螺钉加压内固定治疗距骨骨折15例。其中男11例，女4例，年龄15～61岁；交通事故7例，高处坠落4例，碾压伤2例，扭伤2例。Hawkins分型：I型1例，Ⅱ型6例，Ⅲ型6例，Ⅳ型2例。结果随诊6个月至4年，平均1．5年，骨折愈合良好。Hawkins评分：优9例（I型1例，Ⅱ型5例，Ⅲ型3例），良2例（Ⅲ型），优良率11／15。距骨坏死1例，退行性关节病3例。结论C臂x线机下有限切开撬拨复位空心钉内固定治疗距骨骨折，手术损伤小，对骨膜、软组织血运破坏小，固定可靠，对骨折端有加压作用，有利于骨折愈合。

Objective To study and summary the treatment of talus fracture. Methods Fifteen patients with talus fracture were treated by limited cut off reduction by leverage and hollow lag screw under C arm X-Ray machine January 2008 to November 2014, of whom there were 11 males and 4 females, aged 15 - 61 years old. Seven patients sufferred from talus ＇fracture because of traffic accidents, 4 patients because of falls, 2 patients because of crush injury, and 2 patients because of sprains. Hawkins typing： I type in 1 patient, Ⅱ type in 6 patients,Ⅲ type in 6 patients ofⅢ type, and Ⅳ type in 2 patients. Results Followed up for 6 months to 4 years （mean 1.5 years）, fracture healed better. Hawkins grading standard： 9 patients showed excellent （1 patient of I type, 5 patients of Ⅱ type, 3 patients of Ⅲ type）, and two patients showed good （Ⅲ type）. The excellent and good rate was 11/15. Necrosis of talus occurred in one patient, and degenerative joint disease occured in one patient. Conclusions Minimally invasive internal fixation with hollow lag screw under C arm X-Ray machine in the treatment of talus fracture has a small injury to the periosteum and the blood supply of small soft tissue. It can fix reliably and can pressurize the fracture fragments, and is conducive to fracture healing.