CAJ | 학술논문

目的研究距骨颈骨折的治疗. 方法 1988年10月-2004年6月,按改良Haw-kins法对66例距骨颈骨折患者分型:Ⅰ型14例,行石膏外固定;Ⅱ型34例,行手法复位石膏外固定、切开复位内固定或关节融合术;Ⅲ型16例,行切开复位内固定或关节融合术;Ⅳ型2例,行切开复位内固定或关节融合术.其中陈旧性骨折4例. 结果平均随访6.28年,采用Hawkins评分进行评估,优(29%)19例(Ⅰ型13例,Ⅱ型5例,Ⅲ型1例);良(26%)17例(Ⅰ型1例,Ⅱ型12例,Ⅲ型4例);可(27%)18例(Ⅰ型11例,Ⅱ型6例,Ⅳ型1例);差(18%)12例(Ⅰ型6例,Ⅱ型5例,Ⅳ型1例).距骨缺血性坏死25例(38%),踝及距下关节炎分别为20例(30%)和26例(39%). 结论距骨颈Ⅰ型和Ⅱ型骨折宜石膏外固定,Ⅲ型骨折应切开复位内固定,Ⅳ型和陈旧性骨折宜采用关节融合术.
목적 연구거골경골절적치료. 방법 1988년10월-2004년6월,안개량Haw-kins법대66례거골경골절환자분형:Ⅰ형14례,행석고외고정;Ⅱ형34례,행수법복위석고외고정、절개복위내고정혹관절융합술;Ⅲ형16례,행절개복위내고정혹관절융합술;Ⅳ형2례,행절개복위내고정혹관절융합술.기중진구성골절4례. 결과 평균수방6.28년,채용Hawkins평분진행평고,우(29%)19례(Ⅰ형13례,Ⅱ형5례,Ⅲ형1례);량(26%)17례(Ⅰ형1례,Ⅱ형12례,Ⅲ형4례);가(27%)18례(Ⅰ형11례,Ⅱ형6례,Ⅳ형1례);차(18%)12례(Ⅰ형6례,Ⅱ형5례,Ⅳ형1례).거골결혈성배사25례(38%),과급거하관절염분별위20례(30%)화26례(39%). 결론 거골경Ⅰ형화Ⅱ형골절의석고외고정,Ⅲ형골절응절개복위내고정,Ⅳ형화진구성골절의채용관절융합술.
Objective To study the methods treating talar neck fractures. Methods From Oc-tober 1988 to June 2004, 66 patients with talar neck fractures were treated with different methods. Accord-ing to modified Hawkins classification, there were 14 patients with type Ⅰ fractures treated with plaster exter-nal fixation, 34 with type Ⅱ treated with manipulative reduction plus plaster external fixation, 16 with type Ⅲ treated with open reduction and internal fixation or joint fusion and 2 with type Ⅳ treated with open re-duction and internal fixation or joint fusion. There were four patients with old fractures. Results All pa-tients were followed up for mean 6.28 years and clinical outcomes evaluated according to Hawkins scoring system, which showed that 19 patients (29%) were graded excellent (including 13 type Ⅰ fractures, 5 type Ⅰ and 1 type Ⅲ), 17 good (including 1 type Ⅰ fracture, 12 type Ⅱ and 4 type Ⅲ), 18 fair (including 11 type Ⅱ fractures, 6 type Ⅲ and 1 type Ⅳ) and 12 poor (including 6 type Ⅱ, 5 type Ⅲ and 1 type Ⅳ). There occurred osteonecresis in 25 patients (38%), traumatic arthritis of ankle joint in 20 (30%) and that of subtalar joint in 26 (39%). Conclusions For type Ⅰ and Ⅱ fractures, plaster external fixation should be the choice of treatment. While open reduction and internal fixation should be done for type Ⅲ talar neck fractures and joint fusion for type Ⅳ and old fractures.