摘要
目的探讨空芯拉力螺钉内固定结合骨诱导活性材料治疗HawkinsⅡ、Ⅲ型距骨颈骨折的临床疗效。方法 2005年6月～2011年10月,对收治的37例HawkinsⅡ、Ⅲ型距骨颈骨折患者中34例择期采用经踝关节前内、外侧入路空心加压螺钉结合骨诱导活性材料手术治疗,3例开放性骨折行急诊清创空芯拉力螺钉内固定治疗,全部病例获得12～48个月随访(平均19.6个月)。观察术后伤口愈合、骨折愈合及内固定情况。采用美国足与踝关节协会(AOFAS)踝与后足功能评分对疗效进行评定。结果根据AOFAS评分及术后并发症情况进行评估:优13例(35.1%),良18例(48.6%),可4例(10.8%),差2例(5.4%);优良率为83.7%。发生创伤性关节炎2例,距骨缺血性坏死5例,切口感染1例,局部皮肤坏死1例,无畸形愈合及骨折不愈合发生。结论使用空芯拉力螺钉内固定结合骨诱导活性材料治疗HawkinsⅡ、Ⅲ型距骨颈骨折,骨折固定牢固,骨缺损区充分植入骨诱导活性材料有利于骨折愈合,术后疗效满意。
Objective To explore the clinical efficacy of hollow screw fixation combined with bone inducing material in treating Hawkins type II and Ⅲ fractures of talar neck.Methods A total of 37 patients with talar neck fractures（Hawkins type II and Ⅲ） who were treated from Jun.2005 to Oct.2011 were enrolled in this study.Three patients with open talar neck fracture underwent emergent debridement and hollow screw fixation.The other 34 patients were treated by hollow screw fixation combined with bone inducing material.Using the ankle anteromedial incision or anterolateral operative approach,all cases were followed up for 12 to 48 months（average 19.6 months）.Postoperative wound healing,union of fractures and situation of internal fixations were measured and recorded.The ankle and hindfoot function scoring system established by American Foot and Ankle Society（AOFAS） was used to measure the efficacy.Results According to the ankle and hindfoot function scoring system,the functional results of the ankle were excellent in 13 cases（35.1%）,good in 18（48.6%）,fair in 4（10.8%） and poor in 2（5.4%）.The excellent and good rate was 83.7%.In these patients,traumatic arthritis occurred in 2 cases,avascular necrosis of the talus in 5 cases,incision infection in 1 case and skin necrosis in 1 case.Malunion and non-nion were not found.Conclusion For Hawkins type II and Ⅲ fractures of talar neck,the method of hollow screw fixation combined with bone inducing material can achieve stable fixation,and bone inducing material can promote fracture healing,thus ensuring better clinical efficacy.
出处
《创伤外科杂志》
2013年第4期331-334,共4页
Journal of Traumatic Surgery
