切开复位加压空心螺钉治疗儿童移位距骨骨折疗效分析

Efficacies of open reduction and cannulated compression screw fixation for displaced talus fracture in children

目的探讨切开复位加压空心螺钉固定治疗儿童移位距骨骨折的疗效。 方法回顾分析2011年2月至2014年9月采用切开复位加压空心螺钉内固定治疗的22例儿童移位距骨骨折病例，其中男16例，女6例，年龄3.7～12.3岁（平均7.4岁），18例为高能量损伤，其中17例为高处坠落伤，1例汽车压伤。所有患儿术前均经摄X线片和CT检查明确距骨骨折及移位情况。术中采取前内侧切口（其中1例采用前内侧和前外侧联合入路），直视下复位距骨骨折后1～3枚加压空心螺钉固定（根据骨折部位采用普通加压空心螺钉和埋头加压空心螺钉），术后石膏固定。 结果所有患儿随访时间0.8～4.2年（平均1.5年）。术后石膏固定6周，床上功能锻炼2周后下地行走功能锻炼，术后3个月时采用Hawkins法进行关节功能评估，其中优18例，良4例。随访期间未发现骨不连、距骨坏死及骨性关节炎等并发症，踝关节功能良好，无慢性疼痛，足外观正常，无不适主诉。 结论切开复位加压空心螺钉固定治疗儿童移位距骨骨折可以获得很好的疗效。

ObjectiveTo explore the efficacies of open reduction and cannulated compression screw fixation for displaced talus fracture in children.MethodsFrom February 2011 to September, 22 patients （16 boys and 6 girls） of displaced talus fracture with an average age of 7.4 （3.7-12.3） years were recruited. And 18 cases of injuries were due to traffic accidents and falls. All definite preoperative diagnoses were made by radiography and computed tomography （CT）. Twenty-one patients underwent open reduction and cannulated compression screw fixation by incision of anteromedial foot. Only one case had combined incision of anterolateral and anteromedial foot. Fractures were immobilized postoperatively by cast.ResultsThe average follow-up period was 1.5 （0.8-4.2） years. Cast immobilization was removed at 6 weeks post-operation and in-bed rehabilitation excises were followed by unaided walking. As evaluated by the Hawkins criteria, the functions of ankle and foot were excellent （n=18） and decent （n=4）. During follow-ups, there was no occurrence of bone nonunion, osteonecrosis of talus or osteoarthritis. The appearances of feet were excellent and there was no pain. ConclusionsA combination of open reduction and cannulated compression screw fixation is efficacious for displaced talus fracture in children.