可吸收螺钉固定治疗移位的距骨颈骨折

OPERATIVE TREATMENT OF DISPLACED TALAR NECK FRACTURES WITH ABSORBABLE LAG SCREW

目的 研究距骨颈骨折新的手术治疗方法。 方法 1996年 4月～ 2 0 0 1年 3月 ,采用足内侧途径加内踝截骨显露距骨颈骨折 ,利用可吸收螺钉对骨折行内固定治疗 9例移位的距骨颈骨折。术后膝下石膏管型固定 6～ 12周 ,骨折有明显愈合迹象后 ,患者每日定时在短石膏靴外进行一定范围内活动。 结果 9例均获随访 15～ 6 0个月 ,平均 2 8个月 ,骨愈合时间 2 0～ 4 2周。按 AOFAS足部评分标准 ,功能优良率 77.8% (7/ 9)。术后 1例伤口表浅皮肤感染并皮缘部分坏死 ,为 Hawkins 型。术后随访 2例并发距骨体缺血性坏死 ,1例为 Hawkins 型 ,系 5周即扶拐负重 ,评分为中 ;1例 Hawkins 型 ,经保守治疗无效后行踝关节融合术 ,评分为差。 结论 以足内侧途径为入路 ,应用可吸收拉力螺钉固定治疗距骨颈骨折是一种新手术方法 ,辅以严格的术后处理可获得良好的临床治疗效果 ,值得推广使用。

Objective To study a new kind of operation for displaced talar neck fractures. Methods From April 1996 to March 2001, 9 talar neck fractures were treated by internal fixation of absorbable lag screw with a medial approach and cut of medial malleolus to expose the fractures. A non weight bearing below knee cast was applied for 6 to 12 weeks after operation. Once union of the fracture site is apparent, the patient should remain non weight bearing in a removable short leg and keep exercise every day. Results All the patients received follow up from 15 to 60 months with an average of 28 months. The fractures healed from 20 to 42 weeks. The excellent and good rate of function was 77.8%(7/9) according to American Orthopedic Foot and Ankle Society Score(AOFAS). One case had the complication of superficial infection of wound and skin edge necrosis after operation, which was Hawkins type Ⅲ. Late complication included two cases of avascular necrosis(AVN). Among them, one AVN of Hawkins type Ⅱ was caused by early weight bearing five weeks after operation and gained the fair score. The other AVN of Hawkins type Ⅲ was inefficient to conservative therapy and proceeded ankle fusion in the end. The AOFAS of the patient was bad. Conclusion Treatment of talar neck fractures by internal fixation of absorbable lag screw with a medial approach is an ideal method. It can gain a satisfactory result by the operation, strict postoperative care and rehabilitation.