经内踝截骨入路无头加压螺钉治疗HawkinsⅢ、Ⅳ型距骨颈骨折的临床效果

Treatment of Hawkins typeⅢandⅣtalar neck fractures with headless compression screw via medial malleolus osteotomy

目的:探讨经内踝截骨入路无头加压螺钉治疗HawkinsⅢ、Ⅳ型距骨颈骨折的临床效果。方法:70例HawkinsⅢ、Ⅳ型距骨颈骨折患者,随机分为两组,每组35例。治疗组行经内踝截骨入路无头加压螺钉治疗;对照组行经内踝截骨入路空心加压螺钉治疗。比较两组手术相关指标、患肢功能、远期并发症发生情况。结果:两组患者骨折均获得愈合,切口均获得Ⅰ期愈合;两组术中失血量、手术用时、住院时间无统计学差异(P>0.05);治疗组患肢功能优良率91.43%,高于对照组62.86%,距骨缺血性坏死发生率为11.4%,低于对照组的37.1%(P<0.05)。结论:经内踝截骨入路无头加压螺钉治疗HawkinsⅢ、Ⅳ型距骨颈骨折的效果优于空心加压螺钉法治疗,患肢功能恢复更好。

Objective:To investigate the clinical efficacy of headless compression screw via medial malleolus osteotomy for Hawkins typeⅢandⅣtalar neck fractures.Methods:70 patients with Hawkins typeⅢandⅣtalar neck fractures were randomized into two groups,each with 35 cases.The treatment group were treated with headless compression screw through medial malleolus osteotomy,while the control group were treated with cannulated compression screw via medial malleolus osteotomy.The surgery-related indexes,limb functions and the incidence of long-term complications were compared between the two groups.Results:Facture healing was achieved in both groups,and incision healing was achieved in the first stage.There was no significant difference in the amount of intraoperative blood loss and hospital stay between the two groups(P>0.05).The excellent and good rate of the affected limb function in the treatment group was 91.43%,which was higher than 62.86%in the control group.The incidence of avascular necrosis of talus in the treatment group was 11.4%,which was lower than 37.1%in the control group(P<0.05).Conclusion:The effect of the treatment of Hawkins typeⅢandⅣtalar neck fractures with headless compression screw via medial malleolus osteotomy was better than that with cannulated screw,and the functional recovery of the affected limb was better.