距骨骨折脱位30例诊治分析

目的探讨距骨骨折脱位的特点、类型、手术方法及影响疗效的相关因素。方法 30例距骨骨折脱位患者,均为男性;年龄18～46岁,中位年龄33.6岁。骨折根据Hawkins分型,Ⅰ型4例,Ⅱ型20例,Ⅲ型6例。Ⅰ型距骨骨折采用闭合松质骨拉力螺钉内固定;Ⅱ、Ⅲ型骨折均行急诊手术,采用前外侧或前内侧切口暴露,骨折解剖复位后,以2枚松质骨拉力螺钉交叉内固定;其中Ⅲ型骨折取自体髂骨块跨骨折线嵌入植骨。术后踝关节中立位短腿石膏管形外固定8-12周,复查X线示骨折线模糊后拆除石膏行不负重踝关节活动,骨折线消失后可完全负重行日常活动。结果 30例均获得随访,随访时间1.5～6年,中位数3年。根据AOFAS后足评分系统评定:优10例(33.3%),良13例(43.3%),可5例(16.7%),差2例(6.7%),优良率为76.6%。结论距骨骨折脱位并发症多且后果严重,但可通过急诊手术骨折解剖复位,尽量保护血运,有效内固定,自体髂骨块跨骨折线嵌入植骨,术后力争早期踝关节功能锻炼,可降低病残率。

Analysis on 30 cases of talus fracture combined with dislocation

Objective To investigate the characteristics,classifications,operative methods and related factors of prognosis of talus fracture combined with dislocation.Methods 30 cases of talus fracture combined with dislocation were enroll in the study,all patients were male;age from 18 to 46 years old with mean of 33.6 years,according to Hawkins fracture classification,there were 4 cases belonged to typeⅠwhich were treated with lag screws fixation,typeⅡof 20 cases and typeⅢof 6 cases underwent emergence operation of exposure anterolateral or anteromedial incision,and anatomic reduction and fixation were performed with two cross cancellous bone lag screw fixation,fracture fragments of type III were embedded in bone from the iliac bone block cross fracture line.After operation,all were immobilized with short leg cast for 8～12 weeks,the ankle exercise without burden were began when the fracture line was blur in X ray film and exercise as normal when the fracture line was completely disappeared.Results All of the 30 patients were followed up for 1.5 to 6 years(mean of 3 years).According to the AOFAS hind foot scoring system,excellent were 10 cases(33.3%),good were 13 cases(43.3%),moderate were 5 cases(16.1%),poor were 2 cases(6.1%),overall good rate was 76.6%.Conclusion The complications of talus fracture with dislocation are commonly found with severe outcome,but treated with emergency surgery of anatomical reduction to protect the blood supply,and the effective internal fixation,autogenous iliac bone graft across the fracture line,early postoperative ankle exercise would be helpful for reducing morbidity.