摘要
目的总结距骨外侧突骨折的诊断、治疗方法及临床效果。方法 2001年2月-2009年3月,收治21例距骨外侧突骨折男性患者。年龄18～46岁,平均33.6岁。致伤原因:高处坠落伤18例,摔伤2例,扭伤1例。均为闭合性损伤。受伤至就诊时间为2h～26d。骨折根据Hawkins分型:Ⅰ型4例,Ⅱ型15例,Ⅲ型2例。根据术前CT检查,骨折块≥1cm×1cm×1cm以及移位≥1mm者,采用切开复位AO中空钛钉固定14例,自制门形钉固定1例,可吸收螺钉固定2例;4例骨折块≤0.6cm×0.5cm×0.5cm以及移位≤1mm者,采用骨块摘除2例,克氏针固定1例,石膏固定、保守治疗1例。对损伤韧带同时行修复重建。结果术后切口均Ⅰ期愈合。21例均获随访,随访时间9.5个月～8年。术后患肢踝部无明显疼痛,关节活动范围恢复正常。X线片示骨折均获临床愈合,愈合时间为8～14周,平均10周。采用美国足踝关节协会(AOFAS)后足评分系统评价踝关节功能:获优17例,良3例,可1例,优良率95.24%。结论对于距骨外侧突骨折,应根据骨折块大小及骨折移位程度选择治疗方法 ;对同时伴踝关节外侧韧带损伤,应积极修复,避免慢性外踝不稳定的发生。
Objective To analyse and summarize the diagnosis,treatment,and clinical effects of talus lateral process fracture.Methods Between February 2001 and March 2009,21 male patients with an average age of 33.6 years（range,18-46 years） with talus lateral process fractures were treated.Fracture was caused by falling from height in 18 cases,by tumbling in 2 cases,and by sprain in 1 case.According to Hawkins classification,there were 4 cases of type I,15 cases of type Ⅱ,and 2 cases of type Ⅲ,all being closed fractures.The disease course was from 2 hours to 26 days.In 17 patients whose fracture fragments were more than 1 cm × 1 cm × 1 cm or whose fracture fragments shifting was more than 1 mm,open reduction and internal fixation with AO hollow titanium nails were performed in 14 patients,open reduction and internal fixation with door-shape self-made nail in 1 patient,and open reduction and internal fixation with absorbable screws in 2 patients.In 4 patients whose fracture fragments were less than 0.6 cm × 0.5 cm × 0.5 cm or whose fracture fragments shifting was less than 1 mm,fragments removel was performed in 2 patients,Kirschner pins in 1 patient,and plaster conservative therapy in 1 patient.In patients with ligaments injury,the ligaments was reconstructed during the operation.Results All the incisions achieved primary healing.Twenty-one patients were followed up 9.5 months to 8 years.No ankle pain occurred and the range of joint motion was normal after operation.The X-ray films showed that all cases achieved fracture union.And the healing time was from 8 weeks to 14 weeks（10 weeks on average）.According to American Orthopeadic Foot Ankle Society（AOFAS） for foot,the results were excellent in 17 cases,good in 3 cases,and moderate in 1 case;the excellent and good rate was 95.24%.Conclusion The size and displacement of fracture fragment should be considered first in the treatment of lateral process fracture of talus;in patients who are complicated by lateral malleolus ligament injury,the ligament should be reconstructed to avoid the chronic non-stability of lateral ankle.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第7期878-880,共3页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
距骨外侧突骨折
韧带损伤
诊断
治疗
Talus lateral process fracture Ligament injury Diagnosis Treatment
