CAJ | 학술논문

目的探讨HawkinsⅢ型距骨颈骨折的手术注意事项及临床疗效.方法 2005年3月至2010年3月手术治疗HawkinsⅢ型距骨颈骨折26例,完整随访资料者21例,男13例,女8例;年龄18～50岁,平均37.6岁;左侧11例,右侧10例.坠落伤13例,车祸伤7例,滚落伤l例.闭合骨折15例,开放骨折6例.所有患者均急症采用内、外侧双切口显露、复位骨折,空心拉力螺钉内固定.术后非负重功能位外固定6周,后在铰链支具保护下行踝关节伸屈锻炼,12～16周后根据X线片骨折愈合情况决定是否允许负重,并根据随访结果调整负重量.末次随访时根据美国足与踝关节外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)制定的踝与后足功能评分系统评定术后功能.结果 21例患者术后随访6～60个月,平均36.6个月.平均骨折愈合时间4.5个月,无骨折不愈合.末次随访时AOFAS踝与后足功能评分为45～97分,平均78.6分.优4例、良10例、可5例、差2例,优良率为67.8％.13例患者发生创伤性关节炎,发生率为61.9％( 13/21),累及胫距关节者4例,累及距下关节者6例,同时累及胫距关节、距下关节者3例.发生不同程度距骨缺血性坏死5例,发生率为23.8％(5/21).结论急症采用内、外侧双切口显露、复位骨折,空心拉力螺钉内固定治疗HawkinsⅢ型距骨颈骨折疗效满意.术中注意保护残存血运,根据距骨体三维立体移位特点施行解剖复位,如骨折端粉碎需采取结构性植骨.术后应遵循早运动、晚负重的原则指导功能康复.
목적 탐토HawkinsⅢ형거골경골절적수술주의사항급림상료효.방법 2005년3월지2010년3월수술치료HawkinsⅢ형거골경골절26례,완정수방자료자21례,남13례,녀8례;년령18～50세,평균37.6세;좌측11례,우측10례.추락상13례,차화상7례,곤락상l례.폐합골절15례,개방골절6례.소유환자균급증채용내、외측쌍절구현로、복위골절,공심랍력라정내고정.술후비부중공능위외고정6주,후재교련지구보호하행과관절신굴단련,12～16주후근거X선편골절유합정황결정시부윤허부중,병근거수방결과조정부중량.말차수방시근거미국족여과관절외과협회(American Orthopaedic Foot and Ankle Society,AOFAS)제정적과여후족공능평분계통평정술후공능.결과 21례환자술후수방6～60개월,평균36.6개월.평균골절유합시간4.5개월,무골절불유합.말차수방시AOFAS과여후족공능평분위45～97분,평균78.6분.우4례、량10례、가5례、차2례,우량솔위67.8％.13례환자발생창상성관절염,발생솔위61.9％( 13/21),루급경거관절자4례,루급거하관절자6례,동시루급경거관절、거하관절자3례.발생불동정도거골결혈성배사5례,발생솔위23.8％(5/21).결론 급증채용내、외측쌍절구현로、복위골절,공심랍력라정내고정치료HawkinsⅢ형거골경골절료효만의.술중주의보호잔존혈운,근거거골체삼유입체이위특점시행해부복위,여골절단분쇄수채취결구성식골.술후응준순조운동、만부중적원칙지도공능강복.
Objective To investigate the clinical results and related key points of surgical treatment for Hawkins Ⅲ talus neck fractures.Methods From March 2005 to March 2010,26 patients with Hawkins Ⅲ talus neck fracture were treated and 21 of them were followed,including 13 males and 8 females,with an average age of 37.6 years.The fractures occurred on the left side in 11 patients and on the right side in 10patients.The mechanism of injury included high falling injury in 13 patients,traffic accident injury in 7 patients and rolling down injury in 1 patient.Five cases were closed fractures and 6 cases were open fractures.A bilateral approach,the medial and lateral approaches,was used to perform the operation with cannulated screw fixation in emergency.After external fixation in functional position for 6 weeks without loading,ankle joints were allowed to take exercise with hinge brace and to bear partially basing on plain radiograph 12-16weeks later.The weight-bearing should be adjusted with follow-up.Functional results were assessed according to AOFAS (American Orthupaedic Foot and Ankle Society,AOFAS)score.Results The average duration of follow-up was 36.6 months (range,6-60 months).All fractures gained union and the average union time was 4.5 months.The average AOFAS score was 78.6.There were 4 cases in excellent results,10 in good,5 in fair and 2 in poor.The overall excellent and good rate was 67.8％.Traumatic arthritis occurred in 13 cases and avascular necrosis in 5 cases.Conclusion The effect of surgical treatment for Hawkins Ⅲtalus neck fracture via a bilateral approach is satisfactory.