无头加压全螺纹空心钉治疗移位距骨颈骨折的近期疗效

Short effectiveness of operative treatment of displaced talar neck fractures with Acutrak screws

目的探讨无头加压全螺纹空心钉(acutrak钉)治疗移位距骨颈骨折的近期疗效。方法回顾分析采用无头加压全螺纹空心钉治疗的17例移位距骨颈骨折患者的临床资料,其中男13例,女4例;年龄18~56岁,平均32.5岁;致伤原因:交通事故伤6例,高处坠落伤5例,运动伤5例,重物砸伤1例;左侧7例,右侧10例;合并内踝骨折4例,开放性骨折4例。按Hawkins分型Ⅱ型13例,Ⅲ型3例,Ⅳ型1例;受伤至手术时间6 h^10 d,平均5.2 d。结果术后所有病例均获随访,随访时间9~24个月,平均13.9个月。所有病例伤口均1期愈合。患者扶拐下地部分负重行走时间1~5个月,平均2.9个月。所有病例骨折均愈合,愈合时间3~6个月,平均4.1个月。2例术后半年出现距骨密度增高,1年时复查距骨出现缺血坏死表现。所有病例无神经血管损伤等并发症发生。术后6个月根据AOFAS评分,平均80.4分。结论无头加压全螺纹空心钉治疗移位的距骨颈骨折操作简便、疗效满意、值得推广。

Objective To evaluate the short effectiveness of operative treatment of displaced talar neck fractures with acutrak screws. Methods Between November 2013 and January 2016, 17 patients with the displaced talar neck fractures were treated with acutrak screw, and their clinical data were retrospectively analyzed. There were 13 males, 4 females, and aged 18-56 years. The causes of injury included traffic accident in 6 cases, falling injury in 5 cases, sport injury in 5 cases, weight crushed in 1 case. There were medial malleolus fractures in 4 cases among them, open fractures in 4 cases. According to Hawkins＂ classification, there were 13 cases of type Ⅱ ,3 cases of type Ⅲ, 1 cases of type IV. The time from injury to operation was 6 h-10 d （median, 5.2d）. Results All patients were followed up 9-24 months （mean, 13.9 months） after the operation. All obtained healing of incisions by first intention after operation. There were 1-5 months after operation to bear weights, means 2.9 months. The X-ray films showed that all fractures healed at 3-6 months （mean, 4.1 months）. The density of talus became higher in 2 cases after 6 months and necrosis after 12 months. There was no neurovascular injury. At 6 months, according to AOFAS scoring system, the mean score of all patients was 80.4. Conclusion There is good short effectiveness of operative treatment of displaced talar neck fractures with acutrak screws.