摘要
目的探讨并评价HawkinsⅢ型、Ⅳ型距骨骨折手术治疗方法。方法分别行踝关节内侧或／和前外侧入路，切开复位内固定治疗Ⅲ型距骨骨折9足、Ⅳ型4足。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、骨膜瓣移植术治疗Ⅲ型距骨骨折6足、Ⅳ型3足。内踝截骨或／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、骨膜瓣移植术治疗Ⅲ型骨折12足、Ⅳ型骨折6足。内踝截骨或／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、骨膜瓣移植术治疗Ⅲ型距骨骨折11足、Ⅳ型5足。结果56足获2～11年随访，骨愈合54足，骨不连2足；骨缺血性坏死14足；创伤性关节炎21足。按AOFAS标准评价：优18足，良25足，可11足，差2足，优良率76．8％。结论注意保护骨折部残存血运，重建骨折端血供，是提高复杂距骨骨折脱位术后疗效的关键。以截骨入路，带血管蒂骨膜移植结合切开复位内固定术为最佳手术方案，不需一期行关节融合术。
Objective To investigate and evaluate the techniques and the effect of severe complicated talus fracture - dislocation. Methods All the patients were classified by Hawkins Standard. Thirteen feet were treated by open reduction and internal fixation （ORIF） with anterior or medial approach of ankle joint. Nine feet were treated by ORIF with anterior or medial approach of ankle joint with vascularized periosteum, and bone flap with vascular pedicel transfer. Thirty - four patients 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. Results All the patients were followed up for 2 to 11 years. The excellent outcome was achieved in 18 feet, the good outcome in 25 feet, fair in 11 feet and pool in 2 feet. The excellent and good rate was 76.8 %. Conclusion The protection and reconstruction of the regional blood supply could increase the satisfactory effect, But periosteum implantation with pedicle plus medial malleolus osteotomy or/and lateral tilting of the osteolomized distal end of the fibula approach is the best operation method.
出处
《中国骨与关节损伤杂志》
2007年第5期385-387,共3页
Chinese Journal of Bone and Joint Injury
关键词
距骨
截骨
重建
骨膜瓣
Talus
Osteotomy
Remodeling
Periosteal flap
