摘要
目的探讨距骨颈骨折的治疗方法及近期疗效。方法对22例距骨颈骨折患者根据Hawkins分型,Ⅰ型(4例)骨折者行膝下短腿石膏管形固定,Ⅱ型(11例)和Ⅲ型(7例)骨折者除1例Ⅲ型骨折行距下关节一期融合外,其余采用切开复位螺钉内固定。观察术后伤口愈合、骨折愈合及内固定情况。疗效采用Hawkins标准进行评定。结果 19例获随访,时间12个月～2年10个月。术后1例患者外侧切口皮缘局部坏死,1例伤口感染,经换药及抗感染等对症处理后分别于术后3周及1周治愈;距骨缺血坏死2例,足踝及距下关节创伤性关节炎3例;至末次随访时X线未发现螺钉松动、断裂。Hawkins评分:优11例(Ⅰ型3例,Ⅱ型8例),良5例(Ⅱ型2例,Ⅲ型3例),可2例(Ⅲ型),差1例(Ⅲ型)。结论术前正确的骨折分型、选择合理的治疗方式及恰当的手术时机是治疗距骨颈骨折的有效方法;能减少并发症、提高近期疗效。
Objective To investigate the treatment of talar neck fractures and short-term effect. Methods 22 patients of fractures of talar neck were treated. According to the Hawkins classification, there were 4 cases of type I , 11 of type II and 7 of type III. The type I patients were treated non-operatively, and immobilized by plaster splint, the patients of type II and type m were treated with open anatomic and fixation with screw beyond one patient of type III treated with arthrodesis of subtalar joint primarily. Postoperative wound healing, union of fractures and situation of internal fixations were measured and recorded. The scoring system of Hawkins was used to measure the outcome. Results 19 cases of all the patients were followed up for 12 - 34 months. One patient with local necrosis of wound and one patient with superficial infection after surgery was treated with debridement and antiobiotics. There were two cases of osteonecrosis, there cases of traumatic arthritis of subtalar joint. No loss and rupture of internal fixations were found after surgery by X-ray scanning. According to Hawkins evaluation criteria, 11 patients were excellent （3 type I ,8 type II ）, 5 goo.d（2 type II ,3 type m ） ; 2 fair（type III） and 1 poor（type III ） results respectively. Conclusions Accurate analysis of fracture type preoperatively, selecting a reasonable treatment and appropriate timing of surgery are effective methods for the treatment of talar neck fractures, which can reduce the occurrence of related complications and improve the talar neck fractures term efficacy essential to improve the talar neck fracture surgical healing effect and reduce complications.
出处
《临床骨科杂志》
2012年第3期309-311,共3页
Journal of Clinical Orthopaedics
关键词
距骨骨折
骨折固定术
内
手术后并发症
talar fracture
fracture fixation, internal
postoperative complications
