经后外侧“安全区”行平行螺钉内固定治疗HawkinsⅠ~Ⅲ型距骨颈骨折疗效分析

Effectiveness analysis of percutaneous parallel screw fixation via posterolateral“safe zone”for Hawkins typeⅠ-Ⅲtalar neck fractures

目的探讨经后外侧“安全区”行平行螺钉内固定治疗HawkinsⅠ~Ⅲ型距骨颈骨折的临床疗效。方法回顾分析2019年1月—2021年6月收治且符合选择标准的35例距骨颈骨折患者临床资料。根据手术方式分为研究组(14例,采用经皮后外侧“安全区”行平行螺钉内固定)和对照组(21例,采用传统切开复位前路交叉螺钉内固定)。两组患者性别、年龄、侧别、骨折Hawkins分型及受伤至手术时间等基线资料比较差异均无统计学意义(P>0.05)。记录两组患者手术时间、骨愈合时间、并发症发生情况及Hawkins征情况;末次随访时采用疼痛视觉模拟评分(VAS)及美国矫形足踝协会(AOFAS)踝与后足评分评价患者疼痛及功能改善情况;采用健康调查12项简表(SF-12)评分评估整体生活质量,分为躯体及心理两部分评分;采用5分李克特量表法对患者满意度进行评价。结果研究组手术时间短于对照组,差异有统计学意义(P<0.05)。所有患者均获随访,随访时间13~35个月,平均20.6个月;两组随访时间比较差异无统计学意义(P>0.05)。研究组骨愈合时间显著短于对照组,Hawkins征阳性率(83.33%)显著高于对照组(33.33%),差异均有统计学意义(P<0.05)。对照组术后发生切口延迟愈合2例、骨缺血性坏死7例、关节退变3例、骨不连1例、内固定物激惹3例,研究组仅发生2例关节退变,两组并发症发生率比较差异有统计学意义(P<0.05)。末次随访时,两组VAS评分比较差异无统计学意义(P>0.05),但研究组SF-12躯体和心理评分、AOFAS踝与后足评分以及患者满意度均优于对照组,差异有统计学意义(P<0.05)。结论经后外侧“安全区”行平行螺钉内固定治疗HawkinsⅠ~Ⅲ型距骨颈骨折可获得比传统开放手术更好的临床疗效,具有创伤小、并发症少、恢复快、患者满意度高的优势。

Objective To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral“safe zone”for Hawkins typeⅠ-Ⅲtalar neck fractures.Methods A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021.According to the surgical method,they were divided into a study group(14 cases,using percutaneous posterolateral“safe zone”parallel screw fixation)and a control group(21 cases,using traditional open reduction and anterior cross screw internal fixation).There was no significant difference in gender,age,affected side,Hawkins classification,and time from injury to operation between the two groups(P>0.05).The operation time,bone healing time,complications,and Hawkins sign were recorded,and the improvement of pain and ankle-foot function were evaluated by visual analogue scale(VAS)score and American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hindfoot score at last follow-up.The overall quality of life was assessed by the short form of 12-item health survey(SF-12),which was divided into physical and psychological scores;and the satisfaction of patients was evaluated by the 5-point Likert scale.Results The operation time in the study group was significantly shorter than that in the control group(P<0.05).All patients werefollowed up 13-35 months,with an average of 20.6 months;there was no significant difference in the follow-up time between the two groups(P>0.05).The time of bone healing in the study group was shorter than that in the control group,and the positive rate of Hawkins sign(83.33%)was higher than that in the control group(33.33%),and the differences were significant(P<0.05).In the control group,there were 2 cases of incision delayed healing,7 cases of avascular necrosis of bone,3 cases of joint degeneration,1 case of bone nonunion,and 3 cases of internal fixation irritation;while in the study group,there were only 2 cases of joint degeneration,and there was a significant difference in the incidence of complications between the two groups(P<0.05).At last follow-up,there was no significant difference in VAS score between the two groups(P>0.05),but the SF-12 physical and psychological scores,AOFAS ankle and hindfoot scores,and patients’satisfaction in the study group were significantly better than those in the control group(P<0.05).Conclusion The treatment of Hawkins typeⅠ-Ⅲtalar neck fractures with percutaneous parallel screw fixation via the posterolateral“safe zone”can achieve better effectiveness than traditional open surgery,with the advantages of less trauma,fewer complications,faster recovery,and higher patient satisfaction.