空心加压螺钉治疗距骨颈骨折26例报告

目的：探讨空心加压螺钉治疗距骨颈骨折的体会。方法：2008-08-2013-05,我院共收治距骨颈骨折26例,根据Hawkins分类法分类：Ⅰ型骨折3例,Ⅱ型骨折15例,Ⅲ型骨折7例,Ⅳ型骨折l例,其中Ⅰ型骨折行后路切开空心螺钉;Ⅱ、Ⅲ、Ⅳ型骨折急诊行前内侧入路切开复位空心螺钉内固定。术后短腿石膏托或保护支具固定8～12周,12周内保持不负重状态,拆石膏后视X线复查情况进行活动。结果：26例均获得随访,随访时间3月～5年,平均2.5年;根据Hawkins疗效标准判定,优9例,良12例,可4例,差l例,优良率为80.77%。结论：距骨颈骨折在急诊根据骨折分型采取前路或者后路切开、解剖复位、行空心加压螺钉有效内固定、术后早期功能锻炼等方法治疗,可以减少缺血性坏死几率,值得临床推广。

A report of using the hollow compression screws for the treatment of talus neck fractures in 26 cases

Objective：To discuss the experiences of using the hollow compression screws for the treatment of talus neck fractures.Method：Twenty six patients suffered talus neck fractures were retrospectively analyzed from August 2008to May 2013.According to the Hawkins classification,three were gradeⅠ,fifteen were gradeⅡ,seven were gradeⅢ,and one was gradeⅣ.The patients of grade I were treated by posterior approach with hollow compression screws,and the other grades patients were treated by anteromedial approach with hollow compression screws via emergency operations.After the operations,all the patients were fixed by short leg plaster slab or orthosis for 8～12weeks,kept no heavy burden for 12weeks,and started movement based on X-ray results.Result：All the patients were followed up successfully for 3months to 5years,with the average of 2.5years.According to the Hawkins classification,9patients were rated as excellent,12patients good,4patients fair,and 1poor.The rate of excellent and good was 80.77%.Conclusion：The talus neck fracture should be treated by different approaches according to the fracture situation.The methods of emergency operation,anatomical reduction,effective internal fixation,and early functional exercises after operation could reduce the rate of osteonecrosis,and could be useful for the clinic.