经踝后内侧入路结合无头加压空心钉内固定治疗距骨后突内侧结节骨折

目的评估经踝后内侧入路结合无头加压空心钉内固定治疗距骨后突内侧结节骨折的疗效。方法 2012年1月—2015年12月上海市黄浦区中心医院骨科共收治5例距骨后突内侧结节骨折患者,其中男性3例,女性2例;年龄27~62岁,平均46.2岁。单纯距骨后突内侧结节骨折1例,合并距下关节脱位者4例。所有患者入院后常规行X线摄片及三维CT检查以明确受伤情况,待软组织条件允许后,于伤后1周左右(第4~10天)行经踝后内侧入路切开复位螺钉内固定治疗。术后患者定期复查X线片,并采用美国足踝外科协会(AOFAS)踝与后足评分系统评估功能恢复情况。结果所有患者术后均获随访,平均随访12.3个月(8~14个月)。5例均无伤口感染、神经损伤等并发症发生。术后AOFAS踝与后足评分平均为84分(57~94分)。1例于术后1年继发创伤性关节炎。结论经踝后内侧入路结合无头加压空心钉治疗距骨后突内侧结节骨折安全可靠,术中可清晰暴露,复位固定良好,避免了内踝截骨。

Open reduction and internal fixation of the talus posterior fracture process by headless compression cannulated screw through a posteromedial approach

Objective To evaluate the effects of treating talus posterior fracture by headless compression cannulated screw through posteromedial approach.Methods From Jan.2012 to Dec.2015,5 cases of talus poste-rior fracture were treated,including 3 males and 2 females,aged from 27 to 62 years,with an average of 46.2 years. One case had a simple fracture,and 4 patients had associated joint dislocation.All cases were diagnosed by X-ray and CT scan and treated by headless compression cannulated screw through posteromedial approach.After the soft tissue swelling subsided,about 1 week after injury(4-10days),surgical treatment was applied.Postoperative X-ray films were reviewed regularly and the results were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS).Results All cases were followed up from 8 to 14 months with an average of 12.3 months.They had no postoperative wound infection,and had no nerve injury.The average score of AOFAS was 84(57-94).Only one pa-tient had traumatic arthritis after 1 year.Conclusion Open reduction and internal fixation of the talus posterior fracture process by headless compression cannulated screw through posteromedial approach can not only clearly show fractures and articular surface,but also can avoid malleolus osteotomy.