摘要
目的:探讨切开复位内固定联合铰链式外固定支架治疗复杂距骨骨折的效果。方法:回顾性分析2014年4月至2021年11月手术治疗的26例复杂距骨骨折患者。14例采用切开复位空芯加压螺钉联合铰链式外固定支架治疗(联合组),其中男8例,女6例,距骨颈骨折HawkinsⅢ型6例、Ⅳ型3例,伴脱位的SneppenⅡ型距骨体骨折2例,SneppenⅤ型3例;12例采用单纯空芯加压螺钉治疗(螺钉组),其中男7例,女5例,距骨颈骨折HawkinsⅢ型5例、Ⅳ型3例,伴脱位的SneppenⅡ型距骨体骨折2例,SneppenⅤ型2例。观察术后骨折愈合及晚期并发症发生情况,并按照美国足踝外科协会(AOFAS)踝-后足评分、疼痛视觉模拟评分(VAS)以及患者满意度调查进行临床治疗结果评价。结果:所有患者均获得随访,随访时间12~60个月。末次随访时,联合组AOFAS评分、评估优良率及患者满意度分别为(83.4±14.8)分、85.72%、92.86%,均优于螺钉组[(67.6±22.9)分、41.67%、50.00%,P<0.05]。联合组和螺钉组VAS评分分别为(1.71±1.27)分和(2.08±1.73)分,但两组比较差异无统计学意义(P>0.05)。两组患者骨折均获得骨性愈合,联合组骨折平均愈合时间显著短于螺钉组[(15.6±3.1)周vs.(19.1±5.2)周,P<0.05],联合组后期发生创伤性关节炎2例,距骨坏死1例;螺钉组后期发生创伤性关节炎5例,距骨坏死3例。联合组后期创伤性关节炎或骨缺血性坏死的发生率低于螺钉组,但差异无统计学意义(P>0.05);而联合组后期总体并发症发生率显著低于螺钉组(21.43%vs.66.67%,P<0.05)。结论:运用空芯加压螺钉联合铰链式外固定支架治疗复杂距骨骨折,有利于早期踝关节功能康复、骨和软骨的愈合,减少并发症。
Objective:To investigate the effect of incisional reduction internal fixation combined with a hinged external fixator in treating complex talar fractures.Methods:A retrospective analysis was conducted on 26 patients with complex talar fractures who underwent surgery from April 2014 to November 2021.Fourteen patients were treated with open reduction and hollow compression screws combined with a hinged external fixator(combined group),including 8 males and 6 females,comprising 6 cases of Hawkins typeⅢand 3 cases of typeⅣtalar neck fracture,2 cases of Sneppen typeⅡtalar body fracture with dislocation,and 3 cases of Sneppen typeⅤ.12 cases were treated with hollow-core compression screws(screw group),including 7 males and 5 females.There were 5 cases of Hawkins typeⅢ,3 cases of typeⅣtalar neck fracture,2 cases of Sneppen typeⅡtalar body fracture with dislocation and 2 cases of Sneppen typeⅤ.The postoperative fracture healing and the occurrence of late complications were observed,and the clinical outcomes were evaluated according to the assessment criteria American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,visual analogue scale(VAS)for pain,and patient satisfaction surveys.Results:All patients were follow-up for 12 to 60 months.At the last follow-up,the AOFAS score,assessment excellence rate and patient satisfaction in the combined group were(83.4±14.8),85.72%and 92.86%,respectively,which were significantly higher than those in the screw group[(67.6±22.9),41.67%,and 50.00%,P<0.05].The VAS scores of the combined group and the screw group were(1.71±1.27)and(2.08±1.73),respectively.There was no significant difference in the VAS scores between the two groups(P>0.05).Osseous healing occurred in both groups,and the mean fracture healing time in the combined group was significantly shorter than that in the screw group[(15.6±3.1)weeks vs.(19.1±5.2)weeks,P<0.05].Among the combined group,two traumatic arthritis cases and one talar necrosis case occurred in the late stage.While in the screw group,five traumatic arthritis cases and three talar necrosis cases occurred in the late stage.The incidence of traumatic arthritis or bone ischemic necrosis in the late stage of the combined group was lower than that of the screw group,but the difference was not statistically significant(P>0.05).While the incidence of overall complication in the late stage of the combined group was significantly lower than that of the screw group(21.43%vs.66.67%,P<0.05).Conclusions:The application of hollow-core compression screws combined with a hinged external fixator for treating complex talar fractures is conducive to early functional rehabilitation of the ankle joint,healing of bone and cartilage,as well as reduction of complications.
作者
陈文靖
刘华麒
余国荣
李宗焕
邓玲珑
余黎
CHEN Wenjing;LIU Huaqi;YU Guorong;LI Zonghuan;DENG Linglong;YU Li(Department of Trauma and Microsurgery Orthopaedics,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)
出处
《中华骨与关节外科杂志》
CSCD
2023年第12期1085-1093,共9页
Chinese Journal of Bone and Joint Surgery
基金
武汉大学研究学分课程建设项目(413100076)。
关键词
距骨骨折
切开复位内固定
铰链式外固定架
距骨骨坏死
创伤性骨关节炎
Talus Fracture
Open Reduction and Internal Fixation
Hinged External Fixator
Talus Osteonecrosis
Post-traumatic Osteoarthritis
