距骨尾部骨折及临床意义

通过距骨Ｘ线片及标本的观察，以证实距骨确有头颈体尾四部分，距骨后突骨折实际是距骨尾骨折。对８４８张踝关节侧位片及２００例成人干燥距骨标本进行观察与测量。距骨从整体看形似乌龟，９７％的距骨有距骨，其尾有长、中、短之分，其中距骨尾骨折５２例，占６．８％，认为距骨应分为头、颈、体、尾四部分，对距骨尾部骨折手术切是治疗的关键。这既符合解剖学上命名的完整性，又对临床诊断与治疗具有一定的指导意义。     

距骨尾部骨折16例报告

作者于１９９４年１月￣１９９５年４月处理踝跟部骨折９８例，其中距骨尾部骨折１６例，占踝部骨折１５％。通过Ｘ线片及ＣＴ对距骨形态扫描，作者认为距骨应分头、颈、体、尾四个部分；距骨尾部骨折的治疗以切除为宜。距骨后先天性三角骨不一定存在，可能是距骨尾骨折远端未愈合的游离骨块。     

距骨尾部骨折16例报告

作者于1994年1月～1995年4月处理踝跟部骨折98例,其中距骨尾部骨折16例,占踝部骨折15%.通过X线片及CT对距骨形态扫描,作者认为距骨应分头、颈、体、尾四个部分;距骨尾部骨折的治疗以切除为宜.距骨后先天性三角骨不一定存在,可能是距骨尾骨折远端未愈合的游离骨块.     

距骨尾的命名及距骨尾骨折

为距骨尾命名提供科学依据并研究其骨折的临床意义。方法测量８０４例成人踝部Ｘ线侧位片上距骨尾长度,测量３３０例成人距骨标本上距骨尾的长,宽,厚度,观察距骨尾及整个距骨的形态。结果距骨整体形如乌龟,确有尾成人Ｘ线片距骨尾平均长６．８ｍｍ。按长度分为长尾型（６．６％）、中尾型（７８．３％）,短尾型（１４．２％）、缺如型（０．９％）。骨折５３例（６．６％）。距骨尾在１２岁左右出现,三角骨２７例（３．３％）     

距骨后突骨折合并距骨脱位1例

距骨骨折占全身骨折的0．14％～0．90％,占足部骨折3％～6％下、骨折多见于预和体部,而距骨后突结节骨折较少见．伴有距骨脱位则更少见,笔者于2012—06收治1例此类患者．报告如下．     

距骨颈骨折伴距骨脱位治疗体会

距骨颈骨折伴距骨脱位临床上不多见 ,大多属高速高能损伤所致 ,它是足部最严重的损伤之一。我们近 10年来共治疗 5例 ,现总结治疗体会如下。1　材料与方法1.1　病例资料　本组 5例均为男性 ,年龄 2 8～ 39岁。伤后至手术时间为 2～12h。车祸撞伤 3例 ,高处坠落伤 2例。左侧 2例 ,右侧 3例。开放性 4例 ,闭合性 1例。 5例均伴内踝骨折 ,1例还伴前踝粉碎性骨折。 5例距骨均向内后方脱出。1.2 　治疗方法　在连续硬膜外麻醉下行切开复位内固定术。开放性创口予以仔细彻底清创 ,采用原开放创口清创后延长或踝前侧正中切口 ,暴露骨折端。将嵌入骨…     

距骨体与距骨颈骨折手术疗效分析

目的探讨距骨体与距骨颈骨折患者采用切开复位内固定术在治疗和预后上的差异。方法通过对1996年4月～2003年9月间17例SneppenⅡ型距骨体骨折患者与19例HawkinsⅠ、Ⅱ型距骨颈骨折患者均采用切开复位内固定,将Hawkins评分优良率、距骨缺血坏死率、胫距关节创伤性关节炎发生率和距下关节创伤性关节炎发生率进行对比,使用χ2检验确切概率法分析。结果SneppenⅡ型距骨体骨折患者Hawkins评分优良率为64.7%(11/17),距骨缺血坏死率17.6%(3/17),胫距关节创伤性关节炎发生率41.2%(7/17),距下关节创伤性关节炎发生率64.7%(11/17)。HawkinsⅠ、Ⅱ型距骨颈骨折患者Hawkins评分优良率为73.7%(14/19),距骨缺血坏死率15.8%(3/19),胫距关节创伤性关节炎发生率15.8%(3/19),距下关节创伤性关节炎发生率36.8%(7/19)。四种评价指标两组之间比较,差异无显著性意义(P>0.05)。结论距骨体和距骨颈骨折仅是解剖学上的概念,目前对于两种骨折的预后没有区分意义。对有移位(≥2mm)的距骨体或距骨颈骨折患者均应视软组织条件行切开复位内固定,保护残存血运,解剖复位,减少创伤性关节炎和距骨缺血坏死的发生。     

距骨骨折18例治疗体会

距骨骨折脱位临床并不常见,但其产生的各种并发症可导致患足严重功能障碍,其治疗与解剖和力学原理的关系十分密切。我院2000年1月～2007年12月收治18例距骨骨折患者,报道如下。     

距骨骨折的治疗

目的:探讨距骨骨折的特点、分型、治疗方法及并发症防治。方法:1995年6月～2004年12月共治疗距骨骨折患者52例。根据Hawkins分型方法,Ⅰ型骨折8例,Ⅱ型骨折32例,Ⅲ型骨折10例。另有2例为距骨体骨折。Ⅰ型骨折行保守治疗;Ⅱ、Ⅲ、型骨折中,开放性骨折或伴有脱位的闭合骨折行急诊手术,解剖复位,松质骨拉力螺钉内固定;Ⅲ型骨折同时行距下关节一期融合。术后短腿石膏托或保护支具固定8～12周,并术后早期予CPM(持续被动活动)。至X线片示骨折愈合后逐渐负重。结果:46例获得随访,随访时间4月～5年,平均3.2年。按Howkins疗效标准:优14例(30.4%),良26例(56.5%),可4例(8.7%),差2例(4.3%);优良率为86.9%。术后发生距骨体坏死6例Ⅱ型骨折2例(发生坏死后行关节融合术),Ⅲ型骨折4例。另外,发生距骨下关节炎5例,其中3例合并踝关节炎。发生踝部皮肤坏死2例,伤口感染5例。结论:距骨骨折系高能创伤的结果,并发症多且后果严重,宜早期进行有效解剖复位和固定;术中应首先解决关节脱位,再进行骨折的复位和内固定。手术应力求简单,减少对局部软组织和血运的破坏和干扰,从而减少并发症的发生。术后进行早期功能康复有利用于功能的改善。     

距骨骨折及脱位的手法治疗

距骨骨折是踝关节中较严重的骨折，应及时满意复位，处理不当则后果较严重。本院自1980～1995年共手法复位治疗19例，报告如下。临床资料本组19例中，男16例，女3冽；年龄5～51岁。均为新鲜骨折，其中开放伤2例，距骨体粉碎骨折2冽。合并内、外踝骨折4例，内、外、后、前踝及下肢脏关节分离1例，合并跟骨骨折2例，聪骨骨折1例。按Gilbost’‘’分类：I”距骨颈骨折无移位或轻度移位1例，11”距骨颈骨折合并距下关节脱位或半脱位11例，Ill”距骨颈骨折合并距骨体完全脱位7例。治疗方法全部先以手法复位，石膏外固定治疗，对2例开放伤则先行…     

空心加压螺钉联合钢板内固定治疗距骨颈骨折

目的探讨采用空心加压螺钉联合钢板内固定技术,治疗距骨颈骨折的临床疗效。方法2007年3月至2010年8月,应用空心加压螺钉联合钢板内固定技术,治疗24例闭合距骨颈骨折患者。男15例,女9例;年龄19～52岁(平均35.3岁)。所有患者均采取内外侧联合入路。观察术后骨折复位情况、术后并发症的发生,以及术后功能恢复情况。结果24例患者术后均获随访,随访时间2～4年(平均2.7年)。术后切口均Ⅰ期愈合,23例患者距骨骨折获得愈合,1例患者出现骨折不愈合。未出现切口感染、皮肤坏死等术后并发症。发生创伤性踝关节炎2例,距骨下关节创伤性关节炎3例。按Hawkins疗效评价标准,本组患者优11例,良8例,可3例,差2例,优良率为79.2%。结论空心加压螺钉联合钢板内固定治疗距骨颈骨折,可使骨折固定更加坚固,骨折可获得解剖复位,术后并发症少,临床治疗效果满意,是治疗距骨颈骨折的有效方法。     

The anterior approach for the fixation of displaced talar neck fractures—A cadaveric study

BackgroundTalar neck fractures are rare and are associated with high complication rates. Adequate surgical exposure is essential in the operative management of these challenging injuries. The anterior approach is an alternative to the more commonly described and utilized anterolateral and anteromedial approaches.ObjectiveThe main objective was to compare the surface area of talus visible and quality of exposure via the anterior approach, with the anteromedial and anterolateral approaches.Materials and methodsAn anterior approach was performed on five fresh frozen cadaveric specimens. The surface area of talus visible was measured using an Immersion Digital Microscribe and analyzed with the Rhinoceros 3D graphics package. Standard anterolateral and anteromedial approaches were performed in the same specimens and areas visible measured using the same method.ResultsThe talar surface area visible using the anterior approach is significantly greater than that visible using the anterolateral approach or anteromedial, without and with medial malleolar osteotomy, as well as combination approaches.ConclusionThe anterior approach offers excellent visualization in the fixation of displaced talar neck fractures. Greater talar surface area is visible using this approach compared to traditional approaches.     

Fracture of the posterior process of talus

Fracture of posterior process of talus is quite rare, but is associated with significant morbidity as it involves two articular surfaces. We report two such cases in which open reduction and internal fixation were done with good functional results. One of the cases had a concomitant medial malleolus fracture which to the best of our knowledge has not been reported so far.     

Arthroscopically Assisted Transfibular Talar Dome Fixation With a Headless Screw

We describe an articular talar dome fracture treated with the use of an arthroscopically assisted placement of a transfibular Acutrak screw (Accumed, Hillsboro, OR). This minimally invasive technique can be used to avoid the large incision used in the traditional open reduction and internal fixation of these fractures. Accurate reduction and stable fixation of fractures of the articular surface of the talus is a must, and this technique allows this while avoiding the morbidity of the open approach.     

A Systematic Review of Total Dislocation of the Talus

This review summarizes the treatment and resulting outcomes for total talar dislocation. The PubMed database was searched for articles about humans with total talar dislocation published in the English language in the last twenty years. The following data were entered into a Microsoft Excel spreadsheet: type of dislocation, nature of associated fractures (if any), type of reduction/fixation utilized, immobilization, weight‐bearing status, outcome, complications and average follow‐up time. Thirty‐nine articles reporting a total of 86 cases of total talar dislocation are included in this review. Seventy‐three of these were open injuries and 13 closed. Forty‐three cases had an associated foot or ankle fracture, 32 of those cases specifically having a fracture of the talus. The talus was preserved in the initial management of 74 cases, whereas the remaining 12 cases were managed by primary talectomy. The mean duration of follow‐up was 32 months. Twenty‐two cases required a secondary arthrodesis or another additional procedure. A good outcome was achieved in 35% of cases, a fair outcome in 37% and a poor outcome in 27%. The complication of avascular necrosis (AVN) occurred in 22 cases and 14 subjects developed clinically significant osteoarthritis. Generally, the outcome of current treatments associated with total talar dislocation is not ideal, only 1/3 of cases achieving good outcomes. So far, preservation of the talus is the best treatment option. AVN is still a relatively common complication even in the absence of fracture or postoperative infection.