摘要
目的探讨空芯拉力螺钉内固定结合外固定支架治疗距骨颈骨折的疗效。方法2005年6月至2008年11月共收治25例距骨颈骨折患者。2例开放性距骨颈骨折行急诊清创空芯拉力螺钉内固定结合外固定支架治疗。23例闭合性距骨颈骨折待患者创面、软组织条件改善后，二期行切开复位空芯拉力螺钉内固定结合外固定支架治疗。结果25例患者术后均获8～42个月（平均22个月）的随访。骨折愈合时间平均19周（14～24周）力线正常。创伤性关节炎3例，皮肤坏死2例，距骨缺血性坏死1例，无骨髓炎，无骨不连或畸形愈合，无针道深部感染及固定针松动。临床疗效按AOFAS（美国足与踝关节协会）踝与后足功能评分，优7例（90—100分）；良11例（75～89分）；可5例（50～74分）；差2例（〈50分）。结论根据距骨颈骨折的类型和软组织损伤程度选择合适的手术时机、手术入路和手术方式，使用空芯拉力螺钉结合外固定支架维持骨折复位和关节稳定，骨缺损区充分植骨促进骨折愈合，适当功能锻炼，晚负重，可使距骨颈骨折术后达到良好的疗效。
Objective To examine the clinical efficacy of the cannulated screw fixation combined with eternal fixation for talar neck fractures. Methods A total of 25 patients with talar neck fractures who were treated from June 2005 to November 2008 were enrolled in this study. Two patients with open talar neck fracture underwent emergent debridement, cannulated screw and external fixation. Twenty - three patients with closed talar neck fracture were treated by open reduction and cannulated screw fixation combined with external fixation after improvement of soft tissue conditions of injury. Results All the patients were followed up for 8 to 42 months（ average 22 months）. The average time of fracture healing lasted 19 weeks（ 14 -24 weeks）. Mechanical axis of low limb was normal. In these patients,skin necrosis occurred in 2 cases,traumatic arthritis in 3 cases and avascular necrosis of the talus in 1 case. Nonunion, malunion, osteomyelitis, deep infection and loosening of the fixed needle were not found. According to ankle and hindfoot function scoring system established by American Foot and Ankle Society（AOFAS） ,the functional results of the ankle were excellent in 7 cases（90 - 100 minutes） ,good in 11 （75 - 89 minutes） ,fair in 5 （50 - 74 minutes） and bad in 2 （ 〈 50 points）. Conclusion According to talar neck fracture type and degree of soft tissue injury, appropriate surgical approaches and surgical timing were selected. The cannulated screw fixation combined with external fixation can maintain fracture reduction and joint stability. Bone defect area filled with autogenous bone or artificial bone promotes fracture healing. Appropriate functional exercise and late weight - bearing can help achieve better efficacy in the treatment of talar neck fractures.
出处
《临床外科杂志》
2010年第7期473-475,共3页
Journal of Clinical Surgery
关键词
距骨颈骨折
空芯螺钉
外固定支架
talar neck fracture
cannulated screw
external fixation
