距骨颈骨折的治疗

目的 探讨距骨颈骨折的治疗及愈后。方法 随访89例住院治疗的距骨参骨折患者,其中陈旧骨折15例（16.9%）,并按改良的Hawkin‘s法进行分型,其中Ⅰ型3例,行石膏及闭合克氏针固定;Ⅱ型53例,行切开复位内固定,闭合复位石膏固定及关节融合术等;Ⅲ型29例,行切开复位或关节融合术等;Ⅳ型4例,行切开复位内固定或关节融合术。平均随访5.18年,并依据Hawkin‘s评分进行评估。结果 优22例（24.7%）;良16例（18.0%）;可28例（34.8%）;差19例（22.5％）。其中Ⅱ型以上骨折距骨缺血坏死40.3%（25／62）,踝及距下关节创伤性关节炎分别为26.7%（23／86)及41.8%（36／86）,骨折不愈合7例8.1%。结论 Ⅱ型及Ⅲ型骨折应急诊行切开复位内固定术,可选择经内踝截骨的内侧入路。

Treatment of fractures of the talar neck: long term follow up of 89 cases

OBJECTIVE: To summarize the experience in treating talar neck fractures. METHODS: 89 patients with talar neck fracture were followed up, and classified by modified Hawkin's classification. Three patients of type I were treated with plastic cast and K-wire, 53 of type II with open reduction and internal fixation (ORIF), close reduction and plaster, fusion, and 29 of type III and 4 of type IV with joint fusion and ORIF. RESULTS: Mean follow-up was 5.18 years. Evaluation by Hawkin's criteria, showed 22 patients were excellent, 16 good; 28 fair and 19 poor results respectively. CONCLUSIONS: Emergency operation with ORIF should be performed in type II and type III talar neck fracture. Medial malleolus osteotomy is recommended when medial approach is used.