复杂距骨体骨折的个体化治疗及疗效分析

Individual Treatment and Curative Effect Analysis of Complex Talus Body Fracture

目的探讨复杂距骨体骨折的个体化治疗及临床疗效。方法对2014年1月至2017年12月收治的11例复杂距骨体骨折患者的随访资料进行总结,其中男9例,女2例;年龄25~41岁,平均(29.6±5.9)岁。11例距骨体骨折患者根据Sneppen分型均为Ⅴ型。致伤原因:高处坠落伤7例,交通事故伤3例,重物砸伤1例。受伤至手术时间5~12 d,平均(6.9±1.7)d。手术采用前内侧切口5例,前外侧切口4例,内外侧联合入路2例。所有患者采用无头加压空心螺钉固定。结果所有患者均获随访,随访时间12~48个月,平均(32.4±8.1)个月。无伤口感染及皮肤坏死发生。骨折均愈合,愈合时间12~24周,平均(18.0±3.5)周。踝关节功能采用美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)评分标准评价,优5例,良3例,可2例,差1例,优良率为72.7%。术后2例出现距骨缺血性坏死,行踝关节融合术。结论复杂距骨体应根据骨折形态采取个体化治疗,仔细操作,减少软组织剥离,保护残存血运,晚负重,最大限度地保留患者踝关节功能。

Objective To investigate individual treatmentand curative effectof complex talus body fracture.Methods From January 2014 to December 2017,11 patients with talar body fractures underwentthe operation.There were 2 females and 9 males.The mean age of the patients was(29.6±5.9)years.According to Sneppenclassification,all of them were typeⅤ.The mechanism ofinjury was a fall from the heightin 7 patients,a traffic accident in 3 patients,a crush injury in 1 patients.The mean intervalbetween injuryand surgical treatment for fractures was(6.9±1.7)days.There were 5 cases of anterior-medial incision,4 cases of anterior-lateral incision and 2 cases of combined approach.All patients were fixed with canulated screws.Results All patients were followed up for(32.4±8.1)months.Nonecrosis ofincision and wound infection were found.A11 fractures had achieved bone union;the average healing time was(18.0±3.5)weeks.Functional results were assessed according to A0FAS score.There were 5 patients withexcellent results,3with good result,2 with fair resultand 1with poorresult.Theoverall excellent and good rate was 72.7%.Avascular necrosis occured in 2 cases.Arthrodesis was needed in 2 cases.Conclusion Complex talus body fracture should be treated individually according to the fracture shape,carefully operated to reduce soft tissue dissection,protect the remaining blood supply,late loading,and maximize the preservation of ankle function.