摘要
目的分析复杂距骨骨折脱位不同手术方式的临床疗效,探讨其最佳手术方法。方法自1986年5月至2008年7月我院共收治复杂距骨骨折脱位58例,均属HawkinsⅡ、Ⅲ、Ⅳ型。按治疗方式不同分为4组:A组行踝关节内侧或/和前外侧入路,切开复位内固定,共12例;B组行踝关节内侧或/和前外侧入路,切开复位内固定结合带跗外侧血管蒂骨瓣、骨膜瓣移植,共11例;C组行内踝或/和腓骨下端截骨入路,切开复位内固定结合带跗外侧血管蒂骨瓣、骨膜瓣移植,共20例;D组行内踝或/和腓骨下端截骨入路,切开复位内固定结合带跗内侧或内踝前动脉血管蒂骨瓣、骨膜瓣移植,共15例。根据AOFAS评分系统及术后并发症情况进行评估。结果58例患者均获得随访,平均随访4.3(2～10)年。各组疗效优良率分别为58.3%、63.6%、90.0%、86.7%,总优良率为77.6%。A组骨不连2例,骨缺血性坏死7例,创伤性关节炎6例;B组骨缺血性坏死6例,创伤性关节炎5例;C组创伤性关节炎7例;D组骨缺血性坏死1例,创伤性关节炎5例。结论截骨入路,切开复位内固定结合带血管蒂骨膜瓣移植术保留骨折部残存血运,重建骨折端血供,减少骨不连、骨缺血性坏死等并发症的发生,为复杂距骨骨折脱位最佳手术治疗方案。
Objective To analyze the clinical effects for different operative treatments of complicated talus fracture - dislocations, and evaluate the best treatment method. Methods Total 58 cases of complicated talus fracture -dislocations were operated in our hospital from May 1986 to July 2008. According to Hawkins Standard ,all the cases were typeⅡ,Ⅲ or Ⅳ. 12cases of them were treated by open reduction and internal fixation （ORIF） with anterior or medial approach of ankle joint, 1 lcases were treated by ORIF with anterior or medial approach of ankle joint and vascularized periosteum, and bone flap with vascular pedicel transfer. 35 cases were treated by ORIF with medial malleolus osteotomy or/and lateral tilting of the osteotomized distal end of the fibula approach with vascularized periosteum, and bone flap with vascular pedicel transfer. And the clinical efficacy were evaluated by AOFAS System and postoperative complications. Results All the cases were followed up for 2 to 10 years （4.3 years on average）. The excellent and good rate of each group were 58.3% ,63.6% ,90. 0%and 86. 7% ,and the overall excellent and good rate was 77.6%. There were 2 cases occurred with non - unions, 7, cases with avascular chondronecrosis and 6 cases with traumatic arthritis in A group. 6 cases occurred with avascular chondronecrosis and 5 cases with traumatic arthritis in B group. 7 cases occurred with traumatic arthritis in C group and 1 cases occurred with avascular chondronecrosis and 5 cases with traumatic arthritis in D group. Conclusion ORIF with pedicle plus medial malleobus osteotomy or/and lateral tilting of the osteolomized distal end of the fibula aproach combined with periosteum implantation could protect and reconstruct the regional blood supply and decrease complications of non -unions malunion and avascular chondronecrosis. It is the best operation method of complicated talus fracture -dislocations.
出处
《医药论坛杂志》
2009年第6期8-10,共3页
Journal of Medical Forum
关键词
距骨
骨折脱位
骨膜瓣
截骨
Talus
Fracture - Dislocation
Osteotomy
Periosteal flap
