外固定架与克氏针联合治疗距骨骨折合并距骨脱位的疗效观察

Surgical treatment of fracture-dislocation of the Talus

目的探讨距骨骨折合并距骨脱位采用外固定架与克氏针联合治疗的手术疗效,为距骨骨折合并距骨脱位的手术治疗提供理论依据。方法纳入2015年6月~2016年6月于我院治疗的24例距骨骨折合并距骨脱位患者,其中4例合并内踝骨折、3例合并外踝骨折、5例合并跟骨骨折,12例单纯距骨骨折合并距骨脱位。所有患者经X线检查明确骨折情况后采用硬腰联合麻醉,合并开放性损伤进行一期清创并复位,并采用外固定架联合克氏针治疗。术后6个月、18个月后采用美国足踝学会AOFAS踝-后足评分系统进行踝关节功能评价;术后18个月参照Kenwright评分综合评价手术效果;记录术后并发症发生情况。结果所有患者平均随访(18.23±3.23)月,术后18个月手术效果优10例,良8例,可4例,差2例,手术优良率75.00%;术后6个月AOFAS评分与术后18个月评分比较差异具有统计学意义(P<0.05);术后创伤性关节炎1例,切口感染2例,2例长期踝关节疼痛,2例距骨缺血性坏死。结论距骨骨折合并距骨脱位经外固定架与克氏针联合治疗手术疗效确切,能显著改善踝关节功能,术后需严格注意感染及距骨缺血性坏死等并发症发生。

Objective To investigate the efficacy of fracture-dislocation of talus by external fixation combined with Kirschner wire and provide a theoretical basis for surgical treatment of fracture-dislocation of talus.Methods In this study,24 patients with fracture-dislocation of talus treated in our hospital from June 2015 to June 2016 were enrolled.Among them,4 cases had the complication of medial malleolar fracture,3 cases had lateral malleolar fracture,5 cases suffered from calcaneus fracture,and 12 cases had fracture-dislocation of talus.The fracture condition was clarified by the X-ray examination.All patients underwent one stage debridement and reduction,then received external fixation combined with Kirschner wire on the treatment of open talus fractures after the use of combined spinal and epidural anesthesia.In the postoperative 18~32 months follow-up,the functional results were evaluated by American Orthopaedic Foot and Ankle Society（AOFAS）at the post 6 mon and 18 mon.Then a comprehensive evaluation of surgical effect was made at the post 18 mon.The postoperative complications were recorded.Results The average duration of follow-up was（18.23 ±3.23）months.The result was excellent in 10 cases,good in 8 cases,fair in 4 cases and 2 cases in poor,and the overall excellent or good rate was 75.00%.The AOFAS score was（75.45 ± 4.67）at post 6 mon and was（87.34 ± 5.11）at post 18 mon,with a statistic difference（P〈0.05）.Postoperative traumatic arthritis was found in 1 cases,incision infection in 2 cases,chronic ankle pain in 2 cases,and ischemic necrosis of talus in 2 cases.Conclusion The external fixation combined with Kirschner wire is effective in fracture-dislocation of talus,which can ameliorate the ankle joint function,however,the strict attentions should be paid on the postoperative complications,such as incision infection and ischemic necrosis.