摘要
[目的]探讨关节镜手术治疗距骨骨折的适应证及临床疗效。[方法]回顾性分析2015年1月~2018年6月本院收治的32例闭合性距骨骨折患者。其中男23例,女9例;年龄19~55岁,平均(35.71±7.92)岁。距骨颈骨折19例,Hawkins-Canale分型Ⅰ型6例,Ⅱ型7例,Ⅲ型3例;距骨体骨折11例,Sneppen分型:Ⅱ型5例,Ⅲ型2例,Ⅳ型1例;距骨颈和距骨体同时骨折3例。[结果]本组32例患者手术时间为64~124 min,平均(95.75±16.39)min。2例患者术中距骨体复位困难,经松解后仍无法复位进入踝穴,辅助后外侧小切口用骨膜剥离器进行撬拨复位成功。5例患者术中经反复由后而前置入空心钉时失败,重新消毒将体位变为完全俯卧位后成功。32例患者均获得随访,随访时间16~21个月,平均(18.64±2.17)个月。术后9~12周,平均(10.35±1.42)周下地行走;术后4~7个月,平均(5.61±1.17)个月完全负重行走。末次随访时A0FAS评分为71~95分,平均(88.65±9.34)分。影像方面:术后影像检查显示,32例患者中,22例达到解剖复位,8例距骨移位<2 mm,2例距骨移位≥2 mm。随访影像显示,32例均达到骨性愈合,愈合时间4~8个月,平均(6.38±1.72)个月。至末次随访时,32例中,距骨缺血性坏死1例,创伤性关节炎7例。[结论]关节镜下手术治疗距骨骨折具有微创、直视复位及内固定的优势,术前正确的距骨骨折分型,有利于保证关节镜手术的顺利实施。
[Objective] To evaluate the clinical outcomes of arthroscopic reduction and internal fixation for talus fracture.[Methods] A retrospective study was conducted on 32 patients who underwent arthroscopic reduction and internal fixation for closed talus fractures in our hospital from January 2015 to June 2018. Among them, there were 23 males and 9 females, aged from 19 to 55 years with an average age of(35.71±7.92) years. The fractures involved talus neck in 19 patients, including Hawkins type Ⅰ in 6, type Ⅱ in 7 and type Ⅲ in 3 cases;whereas the talus body in 11 patients, including Sneppen type Ⅱ in 5,type Ⅲ in 2 and type Ⅳ in 1 case;and both talus neck and talus body in 3 patients. [Results] The patients had surgical procedures accomplished from 64 to 124 min with an average of(95.75±16.39) min. A dilemma of fracture reduction met in 2 patients, the bone fragments remained unable to return into the ankle mortise even after release, and was resolved by adding a lateral small incision and poking technique. In addition, the failure of cannulated screw insertion from the rear to the front occurred in 5 patients, which was overcame by changing supine position to prone position. All the 32 patients were followed up for16 to 21 months with an average of(18.64±2.17) months. The patients returned to walking in(10.35±1.42) weeks, and fullweight bearing activity in(5.61±1.17) months on average. At the latest follow up, the AOFAS score ranged from 71 to 95 with an average of(88.65±9.34). With respect to radiographic assessment, the anatomic reduction in 22 patients, reduction with <2 mm displacement in 8 patients and reduction with ≥2 mm displacement in 2 patients were revealed by postoperative images among the 32 patients. As time went during follow up period, all patients got bony healing of the fractures with healing time of 4~8 months with a mean of(6.38±1.72) months. To the latest follow up, the radiographic images showed talus necrosis in 1 patient and traumatic arthropathy in 7 patients among the 32 patients. [Conclusion] Arthroscopic reduction and internal fixation for talus fractures have advantages of minimally invasive interference, reduction and internal fixation under direct vision. However,correct preoperative classification of talus fractures facilitates this arthroscopic surgery.
作者
郭雄飞
王挺
汤立新
GUO Xiong-fei;WANG Ting;TANG Li-xin(Orthope-dic Department,Center Hospital of Nanyang City,Nanyang473002,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2020年第22期2045-2049,共5页
Orthopedic Journal of China
关键词
距骨骨折
关节镜术
内固定
适应证
talus fracture
arthroscopy
internal fixa⁃tion
indications
