中国医学创新
中國醫學創新
중국의학창신
MEDICAL INNOVATION OF CHINA
2015年
24期
122-124,125
,共4页
距骨颈骨折%内固定%双切口%空心拉力螺钉
距骨頸骨摺%內固定%雙切口%空心拉力螺釘
거골경골절%내고정%쌍절구%공심랍력라정
Talus neck fracture%Internal fixation%Two incisions%Hollow lag screw
目的：探讨内、外双侧切口联合空心拉力螺钉内固定急诊治疗HawkinsⅢ型距骨颈骨折的临床疗效。方法：回顾性分析2009年1月-2013年12月急诊手术治疗的41例HawkinsⅢ型距骨颈骨折患者的临床资料。所有患者均急诊给予内、外双侧切口显露进行骨折复位，联合空心拉力螺钉内固定；术后进行随访，采用美国足与踝关节外科协会（AOFAS）制定的踝与后足功能评分系统评价术前及术后功能。结果：41例患者骨折平均愈合时间（4.2±0.6）个月，无骨折不愈合。平均随访时间（37.8±8.3）个月，末次随访时AOFAS功能评分高于治疗前，比较差异有统计学意义（P=0.027），疗效评价中11例为优，17例为良，11例为可，另2例为差，优良率达68.3%。18例（43.9%）患者发生创伤性关节炎，7例（17.1%）发生不同程度距骨缺血性坏死。结论：采用内、外双侧切口显露进行骨折复位，联合空心拉力螺钉内固定急诊治疗HawkinsⅢ型距骨颈骨折的疗效较满意，应依据距骨体移位的特征进行解剖复位，术中需注意保护残存的血运，术后需遵循早运动晚负重的原则进行功能康复锻炼。
目的：探討內、外雙側切口聯閤空心拉力螺釘內固定急診治療HawkinsⅢ型距骨頸骨摺的臨床療效。方法：迴顧性分析2009年1月-2013年12月急診手術治療的41例HawkinsⅢ型距骨頸骨摺患者的臨床資料。所有患者均急診給予內、外雙側切口顯露進行骨摺複位，聯閤空心拉力螺釘內固定；術後進行隨訪，採用美國足與踝關節外科協會（AOFAS）製定的踝與後足功能評分繫統評價術前及術後功能。結果：41例患者骨摺平均愈閤時間（4.2±0.6）箇月，無骨摺不愈閤。平均隨訪時間（37.8±8.3）箇月，末次隨訪時AOFAS功能評分高于治療前，比較差異有統計學意義（P=0.027），療效評價中11例為優，17例為良，11例為可，另2例為差，優良率達68.3%。18例（43.9%）患者髮生創傷性關節炎，7例（17.1%）髮生不同程度距骨缺血性壞死。結論：採用內、外雙側切口顯露進行骨摺複位，聯閤空心拉力螺釘內固定急診治療HawkinsⅢ型距骨頸骨摺的療效較滿意，應依據距骨體移位的特徵進行解剖複位，術中需註意保護殘存的血運，術後需遵循早運動晚負重的原則進行功能康複鍛煉。
목적：탐토내、외쌍측절구연합공심랍력라정내고정급진치료HawkinsⅢ형거골경골절적림상료효。방법：회고성분석2009년1월-2013년12월급진수술치료적41례HawkinsⅢ형거골경골절환자적림상자료。소유환자균급진급여내、외쌍측절구현로진행골절복위，연합공심랍력라정내고정；술후진행수방，채용미국족여과관절외과협회（AOFAS）제정적과여후족공능평분계통평개술전급술후공능。결과：41례환자골절평균유합시간（4.2±0.6）개월，무골절불유합。평균수방시간（37.8±8.3）개월，말차수방시AOFAS공능평분고우치료전，비교차이유통계학의의（P=0.027），료효평개중11례위우，17례위량，11례위가，령2례위차，우량솔체68.3%。18례（43.9%）환자발생창상성관절염，7례（17.1%）발생불동정도거골결혈성배사。결론：채용내、외쌍측절구현로진행골절복위，연합공심랍력라정내고정급진치료HawkinsⅢ형거골경골절적료효교만의，응의거거골체이위적특정진행해부복위，술중수주의보호잔존적혈운，술후수준순조운동만부중적원칙진행공능강복단련。
Objective:To investigate the clinical effect of internal and lateral bilateral incisions combined with hollow lag screw fixation in the emergent treatment of HawkinsⅢtalus neck fracture.Method:The clinical data of 41 patients who received emergent treatment for HawkinsⅢtalus neck fracture in our hospital from January 2009 to December 2013 were collected.All the patients were given the treatment of internal and lateral bilateral incisions combined with hollow lag screw fixation.Postoperative follow up was given to the patients,the function before and after the treatment was evaluated by the scoring system of ankle and hindfoot function which was formulated by AOFAS.Result:The average healing time was(4.2±0.6)months,there was no patients without fracture healing.The average duration of follow-up was(37.8±8.3)months.The average AOFAS score of the final follow up was higher than before treatment,the difference was statistically significant(P=0.027).There were 11 patients with excellent results,17 patients with good results,11 patients with fair results and 2 patients with poor results,the excellent and good rate was 68.3%.Traumatic arthritis occurred in 18 patients(43.9%)and avascular necrosis occurred in 7 patients(17.1%). Conclusion:The effect of internal and lateral bilateral incisions combined with hollow lag screw fixation in the treatment of Hawkins Ⅲtalus neck fracture is satisfactory.Anatomical reduction shall be conducted according to the displacement features of talus.The remaining blood supply shall be protected during the operation.After the operation,patients shall take functional rehabilitation exercise according to the principle of early exercise and late weight-bearing.
