43例距骨颈骨折手术疗效分析

目的]探讨距骨颈骨折手术治疗辅助康复锻炼的疗效及预后。方法]根据改良Hawkins的距骨颈骨折分类法进行分型，其中I型，行闭合皮质骨螺钉以及支具固定。Ⅱ型，闭合或切开复位皮质骨螺钉内固定以及克氏针、支具固定。Ⅲ型、Ⅳ型，行切开复位皮质骨螺钉内固定或关节融合术。术后均采取早期康复锻炼。结果]平均随访时间3．4年（1_6．5年），并根据Weber评分标准评估。其中优16例，良12例，中8例，差7例，优良率为65．1％，距骨体缺血坏死11例，踝及距下关节创伤性关节炎4例，畸形愈合7例，无骨折不愈合病例。结论]选择软组织创伤较小的手术入路，以及恰当的复位和内固定方法，辅助康复锻炼有助于距骨颈骨折的预后。

Fracture of the talar neck: an analysis of 43 cases

Objective]To study the experience of operative treatment assisted by rehabilitation exercises on the talar neck fracture. Method]According to Hawkins classification, 2 cases of type I were treated with lag screws and closed reduction; 26 cases of type II were treated with open (or closed) reduction and internal fixation (ORIF); 15 cases of type III and type IV were treated with joint fusion ORIF. Early-stage rehabilitation exercises were carried out postoperatively.Result]All patients were followed up for a mean 3.4 years (ranged, 1~6.5 years). According to evaluatin by Weber's criteria, the results were excellent in 1 case, good in 12 , fair in 8 and poor in 3 respectively. The satisfactory rate was 65%. Avascular necrosis of talus body, post-traumatic osteoarthritis and malumon occurred in 11, 4 and 7 cases respectively. No non-union was found.Conclusion]Proper reduction and internal fixation with systematic rehabilitation and the minimal soft tissue incision are the key to reaching a good clinical result.