距骨后突内侧结节骨折

目的分析讨论距骨后突内侧结节骨折的早期诊断及治疗。方法 利用ＣＴ确诊５例距骨后突内侧结节骨折病例。对胃及距下关节面的３例患者,２例采用切开复位内固定术,１例因拒绝手术而行保守治疗。另外２例,１例给予石膏固定６周,１例行骨块切除术。结果 本初诊确诊４例,漏诊１例,平均随访２４个月。１例漏诊患者因６个月后骨折不愈合伴疼痛、足底麻木而行骨块切除,术后疗效满意;其余４例中３例疗效满意,１例接受保守治疗者     

距骨后突内侧结节骨折的诊治

目的探讨距骨后突内侧结节(PMTT)骨折诊断与治疗的有效方法。方法1993年6月～2002年1月收治18例PMTT骨折患者中,初诊确诊15例,漏诊3例;对14例累及距下关节面者8例采用切开复位内固定术,5例行手法复位石膏固定,1例骨折移位较大者因拒绝手术而保守治疗;另外4例骨折不累及关节面者,3例石膏固定6周,1例行骨块切除术。结果平均随访41.7个月。1例早期漏诊患者行骨块切除术后,疗效满意;其余患者根据美国足踝骨科协会(AOFAS)评分:优7例,良6例,可3例,差1例。结论PMTT骨折有其诊断特点,需经CT确诊;手术治疗可选择半螺纹钛钉加压埋头固定;漏诊患者行骨块切除术可获得满意疗效。     

距骨后突内侧结节骨折的早期诊治

目的 探讨距骨后突内侧结节骨折诊断与治疗的有效方法.方法 自2000年7月～2007年1月共收治4例距骨后突内侧结节骨折,3例行切开复位内固定术,1例行石膏托外固定术.结果 平均随访18.6个月.根据美国足踝骨科协会后踝评分系统:优3例,良1例.结论 距骨后突内侧结节骨折临床少见,容易漏诊,手术治疗可获得满意疗效.     

一例距骨后突内侧结节骨折的病例报告

距骨后突内侧结节 (Posterior medial tubercle of the talus , PMTT) 骨折在临床上比较少见,目前临床上对于此类损伤报道较少。由于PMTT的特殊解剖位置,骨折后对于踝关节的功能影响较大,临床初诊行踝关节正侧位X线片容易漏诊或误诊。本人于2014年3月收治一例此类损伤患者,随访2年余踝关节功能恢复良好,现报告如下：     

距骨后突内侧结节骨折--附4例临床报告

目的：探讨距骨后突内侧结节骨折的诊断和治疗。方法回顾性分析1995年12月至2006年6月本院收治的4例距骨后突内侧结节骨折临床资料。结果本组1例石膏固定,2例切开复位内固定,1例早期漏诊,患者拒绝手术。所有患者获得随访,随访12~48个月,平均2.2年。全部病例均采用美国足踝骨科协会后足踝评分系统,优2例,良1例,可1例。术后无单纯踝关节炎、距骨下关节炎,无距骨体坏死、塌陷或疼痛性关节炎,无伤口感染和踝关节内侧皮肤坏死。结论常规CT检查可早期明确诊断,移位的距骨后突内侧结节骨折应切开复位内固定。     

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．     

距骨内侧突骨折治疗方法探讨

距骨内侧突又称为距骨后突内侧结节(posterior medial tubercle of the talus,PMTT),于1974年Cedell首次报道,故又称为Cedell骨折。在此发生骨折极为少见,仅有少量的相关病例报道。由于缺乏规范化的诊断及治疗方法的总结,临床医师诊断较为困难,容易漏诊。2004年3月～2009年11月,我院收治3例距骨内侧突骨折分别给予保守、切开复位内固定治疗,取得较好的疗效,现报告如下。     

Mimics软件重建距骨模型结合踝后内侧入路治疗距骨后突骨折

目的评价术前Mimics软件重建距骨后突骨折三维模型,结合踝后内侧入路治疗距骨后突骨折的优势。方法回顾性分析北京积水潭医院创伤骨科2015年5月至2019年2月采用术前Mimics软件重建距骨后突骨折三维模型结合踝后内侧入路治疗的7例距骨后突骨折患者资料。男5例,女2例;年龄20~70岁,平均39岁。术前常规行CT检查,应用Mimics软件基于CT扫描数据三维重建距骨后突以明确骨折块大小、数量和移位程度,踝后内侧入路切开复位螺钉内固定治疗距骨后突骨折。术后采用美国足踝外科协会(AOFAS)的踝-后足评分系统评估功能恢复情况。结果本组患者手术时间70~105 min,平均87.1 min。术后早期伤口均愈合良好,无神经、肌腱损伤。所有患者术后随访4~24个月,平均12个月。10~16周复查X线片骨折愈合,未发现断钉、骨不连和畸形愈合及创伤性关节炎等并发症发生。末次随访时AOFAS的踝-后足评分为80~98分,平均87分。结论术前CT影像基于Mimics软件重建距骨后突骨折三维模型可精确定位进钉点和进钉方向,用于踝后内侧入路术中有清楚显露、骨折易复位、置钉方便的优势。     

经踝后内侧入路切开复位内固定治疗距骨后突骨折

目的 评估经踝后内侧入路切开复位内固定治疗距骨后突骨折的疗效.方法 2006年1月至2008年12月共收治12例距骨后突骨折患者,男8例,女4例;年龄24～66岁,平均46.2岁.其中单纯距骨后突骨折7例,合并距骨体骨折2例,合并距下关节脱位3例.所有患者入院后常规行X线摄片和CT三维重建明确受伤情况,待软组织条件允许后,平均于伤后第5天(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 10例患者术后获平均18个月(12～48个月)随访.所有患者术后均无伤口感染、神经损伤等并发症发生.术后AOFAS踝与后足评分平均为83分(58～95分).2例患者于术后1年继发创伤性关节炎,其中1例因疼痛及行走困难而行距下关节融合术. 结论 经踝后内侧入路治疗距骨后突骨折安全可靠,术中暴露清晰,有利于复位固定,且可避免内踝截骨.     

距骨后突内结节骨折术后疼痛：1例报告和综述

距骨后突内侧结节骨折,也称为Cedell撕脱性骨折或Cedell骨折,临床极为罕见,易漏诊。本文结合1例临床病例,并对文献进行综述为临床医师提供参考。Cedell骨折,运动损伤最多61.3%,高能量损伤次之38.7%,初诊时漏诊率64.5%。目前的治疗方法主要是切开复位内固定术、骨块切除术、支具或石膏固定术,根据现有研究还不能指出Cedell骨折的典型创伤机制,也不能提出哪一种治疗方案更佳。     

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.     

距骨颈骨折伴距骨体Ⅲ度后脱位的治疗

距骨体后脱位的Ⅲ度距骨颈骨折,临床少见,此型骨折,应急症复位固定,减轻损伤,降低距骨坏死率,但闭合手法整复困难,即使开放复位固定,距骨体也不易还纳,有时需切断跟腱,方能复位,加重了组织创伤,我院自1999年11月-2002年5月共收治此类损伤6例,采用术前X线片分型,术中结合相应手法,协助手术复位固定,取得了理想效果,现分析报告如下.……     

Diagnosis of medial tubercle fractures of the talar posterior process using oblique views

Fracture of the medial tubercle of posterior process of talus is a very rare injury. Often, these fractures are not seen on the AP and lateral radiographs of the ankle joint resulting in them being misdiagnosed as an ankle sprain. This study examines 10 ankle specimens simulated with a posteromedial fracture in varying planes, by multiple X-ray views in varying angles of external rotation in order to increase the sensitivity of oblique views to diagnose a fracture of the posteromedial tubercle. True AP and lateral views (0 degrees and 90 degrees of external rotation) of the ankle joint were unable to detect the fracture simulated in the posteromedial tubercle of the posterior process in any specimens. The fractures in all the specimens were clearly visible when the X-ray beam was parallel to the plane of osteotomy. The fractures could still be identified when the plane of X-ray beam was within +/-10 degrees from the plane of osteotomy. Any further increase or decrease in plane of the X-ray beam could not identify the fracture. Two oblique views at 45 degrees and 70 degrees of external rotation could identify the fractures of the posteromedial tubercle at all planes. These oblique views can be used before resorting to the CT scan.     

Avulsion fractures of the medial tubercle of the posterior process of the talus

Avulsion fracture of the medial tubercle of the posterior process of the talus occurs after forceful dorsiflexion-pronation of the ankle. We evaluated five patients who had sustained this fracture while participating in sporting activities. Two patients were correctly diagnosed acutely and treated with immobilization and limited weightbearing. Avulsion fractures in the remaining three patients went undiagnosed acutely. This group was treated with delayed operative excision for persistent posteromedial ankle pain. The patients were evaluated at a mean follow-up of 35 months using the AOFAS Ankle-Hindfoot Scale. The two patients diagnosed and treated acutely achieved excellent results. The three patients with missed fractures did poorly, yet achieved comparable results after late excision. Our results suggest that prompt diagnosis and appropriate management yields reliably good outcomes. Untreated avulsion fractures predictably do poorly. For these patients, late excision can provide significant functional and symptomatic improvement.     

后内侧改良L形切口治疗复杂后pilon骨折的临床效果

背景:在后pilon骨折中,对于后内侧骨折块移位明显,累及内踝前丘或完全内踝骨折,或存在Die-punch骨块的复杂骨折,传统体位及手术入路常存在骨折显露不充分及复位困难等问题.目的:探讨俯卧位下后内侧改良L形切口治疗复杂后pilon骨折的手术技巧及临床疗效.方法:选取2016年5月至2018年12月收治的复杂后pil...     

Associated lateral process and posteromedial tubercle talus fractures with entrapment of the medial neurovascular bundle: A case report

This paper describes a case of an isolated fracture of the lateral process of the talus associated with a fracture in the posteromedial tubercle of the talus with entrapment of the medial neurovascular bundle. Currently no similar cases have been published describing this type of neurovascular bundle injury. Furthermore, in contrast to previously published cases, both fractures were treated surgically despite the absence of posteromedial tubercle fracture displacement. This article reviews the literature and provides useful recommendations for the clinical management of similar cases in the future.     

空心加压螺钉治疗距骨外侧突骨折17例

距骨外侧突骨折(fracture of the lateral process of the talus)临床相对少见,国内外报道较少[1-3].2001年3月至2009年4月收冶17例距骨外侧突骨折病例行空心加压螺钉内固定,报告如下.     

股骨粗隆间骨折262例治疗分析

目的 :分析不同方法治疗股骨粗隆间骨折的疗效。方法 :股骨粗隆间骨折 2 6 2例 ,其中非手术治疗 12 0例 ,手术治疗 142例。结果 :与非手术组相比 ,手术组后并发症发生率低 ,住院时间短。经长期随访 ,手术组优良率为 90 % ,非手术组优良率为 87% ,两组间无显著性差异 (P>0 .0 5 )。结论 :手术治疗为首选的方法     

Avulsion fracture of the medial tubercle of the posterior process of the talus: Three-dimensional (3D) computed tomography features

Fractures of the medial tubercle of the posterior talar process are rare avulsion fractures, which commonly remain undetected during the first presentation of the patient in the Emergency Department, simulating a more benign ankle sprain. The diagnostic evaluation using three-dimensional (3D) computed tomography (CT) and the successful conservative treatment of a medial tubercle fracture in a young athlete is presented.