关节镜下复位内固定治疗距骨体骨折的临床研究

Effect of arthroscopic reduction and internal fixation in treatment of talar body fractures

背景:传统切开复位内固定治疗距骨体骨折存在预后差、并发症多等缺点,而关节镜下复位内固定技术治疗各类骨折变得越来越流行。目的:评估关节镜下复位内固定治疗距骨体骨折的临床疗效。方法:选取2015年2月至2018年5月我院关节镜下复位内固定治疗距骨体骨折患者10例,其中男7例,女3例;年龄14~52岁,平均(31.7±13.9)岁。末次随访时踝关节进行物理检查和X线检查。踝关节功能应用美国足与踝关节协会(AOFAS)踝与后足功能量表进行评定。结果:关节镜复位内固定的10例患者手术时间190~450 min,平均(326±72)min。所有伤口均一期愈合。10例患者(11个距骨体)均获得随访,随访时间18~46个月,平均(27.5±9.3)个月。在随访中,发现有1例患者发生了创伤性骨关节炎,未发现距骨坏死、骨折不愈合。依据美国足与踝关节协会踝与后足功能量表,对踝关节功能进行评定:优5个,良6个。结论:关节镜下复位内固定治疗距骨体骨折是一种有效的手术方法,对踝关节造成的二次创伤小、术后并发症少、恢复快、使踝关节结构保持的更完整。

Background:Open reduction and internal fixation for talar body fracture has the disadvantages of poor prognosis and many complications.Arthroscopic reduction and internal fixation is becoming more and more popular in treating various fractures.Objective:To investigate the effects of arthroscopic reduction and internal fixation in treatment of talar body fractures.Methods:Ten patients with talar body fractures undergoing the arthroscopic reduction and internal fixation procedures from February 2015 to May 2018 were selected including 7 males and 3 females,with the mean age of(31.7±13.9)years(range,14-52 years).At final follow-up,physical examination and X-ray examination of the ankle joint were performed.Function of the ankle joint was assessed by the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score.Results:The operative times of ten patients ranged from 190 to 450 min with the mean of(326±72)min.All wounds healed well.Ten patients were followed up for 18-46 months with the mean of(27.5±9.3)months.During the follow up one patient occurred the peri-talar traumatic osteoarthritis.Bony nonunion and osteonecrosis were not found.According to the AOFAS ankle-hindfoot score,there were five patients as excellent and 6 as good.Conclusions:Arthroscopic reduction and internal fixation in the treatment of talar body fracture is an effective and feasible procedure,and it has less trauma to the ankle joint,fewer complications,faster recovery and more complete joint structure.