HawkinsⅢ型距骨颈骨折内外双侧切口联合空心拉力螺钉内固定急诊治疗应用.docVIP

HawkinsⅢ型距骨颈骨折内外双侧切口联合空心拉力螺钉内固定急诊治疗应用 　　【摘要】 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。 　　【关键词】 距骨颈骨折； 内固定； 双切口； 空心拉力螺钉 　　Application of Internal and Lateral Bilateral Incisions Combined with Hollow Lag Screw Fixation in the Emergent Treatment of HawkinsⅢ Talus Neck Fracture/ZHAN Shi-ben，MAI Hong-fei.//Medical Innovation of China，2015，12（24）：122-125 　　【Abstract】 Objective：To investigate the clinical effect of internal and lateral bilateral incisions combined with hollow lag screw fixation in the emergent treatment of HawkinsⅢ talus neck fracture.Method：The clinical data of 41 patients who received emergent treatment for HawkinsⅢ talus 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%） a