距骨骨折治疗方法的选择及疗效分析

摘要

目的:探讨距骨骨折治疗方法的选择并分析其疗效.方法:1998年10月至2009年10月,共治疗距骨骨折患者44例,其中38例获得随访,男28例,女10例;年龄19～65岁,平均33.5岁.采用石膏外固定10例、切开复位内固定22例、Ⅰ期Blair胫-距-跟融合术6例.按Matti-Weber分型:Ⅰ型3例,Ⅱ型15例,Ⅲ型16例,Ⅳ型4例.采用Hawkins评定标准通过疼痛、关节活动度、有无跛行等方面进行疗效评估.结果:38例患者的平均随访时间为4.8年(1～11年).按Hawkins标准,石膏外固定10例中.优4例,良2例,可3例,差1例.切开复位内固定22例中,优2例,良6例,可6例,差8例.其中结果为差的8例,术后3～5年,均实行了Ⅱ期关节融合术,1例术后患肢短缩3 cm,跛行,患者拒绝进一步治疗,评价为差,余7例效果均为可.Ⅰ期Blair胫-距-跟融合术6例中,良1例,可4例,差1例.随访期内发现距骨缺血性坏死12例,创伤性关节炎13例.结论:距骨骨折并发症多见且预后欠佳.骨折损伤程度与预后相关.距骨骨折移位小于2 mm宜石膏外固定;手法复位后骨折移位大于2 mm应切开复位内固定;骨折合并距骨体全脱位或者关节面不能修复的粉碎骨折宜采用Blair胫-距-跟融合术.%Objective:To explore the choice of therapeutic methods for talar fractures and analyze its clinical effects.Methods: From October 1998 to October 2009,44 patients with talar fractures were treated in the study ,of them, 38 cases obrained follow-up,in which 10 cases with plaster external fixation,22 cases with open reduction and internal fixation,6 cases with Blair joint fusion. There were 28 males and 10 females,ranging in age from 19 to 65 year with an average of 33.5 years.According to classification of Matti-Weber, type Ⅰ was in 3 cases, type Ⅱ in 15, type Ⅲ in 1 6, type Ⅳ in 4. The clinical effects were evaluated by the Hawkins standard including pain ,active range of the joint, limping. Results :The mean time of follow up was 4.8 years (range, 1 to 11 years). According to the Hawkins standard,in 10 cases with plaster external fixation ,4 cases obtained excellent results,2 good,3 fair, 1 poor; in 22 cases with open reduction and internal fixation,2 case obtained excellent results, 6 good, 6 fair, 8 poor (the 8 patients accepted second treatment with joint fusion at 3 to 5 years after operation, affected limb of I patient occurred crispation for 3 cm,walking with limp,and further treatment was refused result in poor,and others got fair results) ;in 6 cases with Blair joint fusion, 1 case obtained good results,4 fair, 1 poor. Diaz disease was found in 12 cases and traumatic arthritis was found in 13 cases in the period of follow-up. Conclusion:Talar fracture usually results in complications and gets bad prognosis. The prognosis is relative with the traumatic degree. Plaster external fixation beseems to the displacement of fracture less than 2 mm;open reduction and internal fixation beseems to the displacement of fracture more than 2 mm; Blair joint fusion beseems to talar body fracture with total dislocation or whose talar body fracture is comminuted severely and the surface of joint can not be repaired.