经内踝Chevron截骨治疗距骨骨折的临床疗效分析

Clinical effect of Chevron medial malleolar osteotomy for talus fracture

背景：目前距骨骨折的手术治疗方法较多,经内踝Chevron截骨入路治疗距骨骨折的临床报道较少。目的：观察分析经内踝Chevron截骨手术治疗距骨骨折的临床疗效。方法：2009年1月至2013年9月共收治闭合性距骨骨折20例,男15例,女5例;年龄21-60岁,平均38.3岁。其中距骨颈骨折14例,根据Hawkins分型,Ⅱ型10例,Ⅲ型4例;距骨体骨折6例,根据Sneppen分型,Ⅱ型3例,Ⅲ型2例,Ⅵ型1例。均经内踝行Chevron截骨暴露距骨,无头加压空心螺钉固定。采用美国足踝外科协会（AOFAS）踝一后足评分系统评价术后功能。结果：17例患者获得随访,随访时间11-35个月,平均18个月,均获得骨性愈合,无感染,无复位丢失、内固定松动。术后AOFAS评分为（76.8±8.5）分（64-90分）。1例出现严重创伤性骨关节炎,行距下关节融合,2例关节退变较轻,行保守治疗。结论：经内踝Chevron截骨可充分暴露距骨,能获得距骨的解剖复位,临床疗效优良。

Background：There are many treatment methods for talar fractures,but the reports regarding the Chevron medial malleolar osteotomy are rare.Objective：To discussed the clinical effect of Chevron medial malleolar osteotomy for fixation of talus fracture.Methods：From January 2009 to September 2013,20 patients with closed fractures of talus were treated by Chevron medial malleolar osteotomy.There were 15 men and 5 women with a mean age of 38.3 years（range,21-60 years）.The neck of the talus was injured in 16 cases（according to Hawkins classification,there were 10 cases of type Ⅱ and 4 cases of type Ⅲ.The body of the talus was involved in the other 6 cases（according to Sneppen classification,there were 3 cases of type Ⅱ,2 cases of types Ⅲ and 1 case of type Ⅳ）.All fractures were fixed with cannulated compression screws through chevron medial malleolar approach.The AOFAS score was used to evaluate clinical outcomes.Results：Seventeen patients were followed up,and the mean follow-up was 18 months（range,11-25 months）.All of them achieved bone union.No infection,screw loosening or reduction loss occurred,postoperative mean AOFAS score was 76.8±8.5（range,64-90）.The injury in one case developed to severe traumatic osteoarthritis,which was treated by subtalar joint arthrodesis.The injury in two cases developed to joint degeneration and treated by conservative treatment.Conclusions：The Chevron medial malleolar osteotomy approach can provide sufficient area for fixation of talus fracture.The anatomical reduction of the talus and satisfactory clinical effect can be achieved.