Jarde O, Boulu G, Havet E, Gabrion A, Vives P
Service d'Orthopédie-Traumatologie, CHU Nord, Amiens, France.
Acta Orthop Belg. 2001 Feb;67(1):60-7.
The authors report a series of 32 complete transverse fractures of the neck or body of the talus. The fractures occurred mostly in young males, as a result of motor vehicle accidents. The fracture line was transverse in the neck or body of the talus in 20 cases, sagittal in four and comminuted in eight cases. Using Hawkins' classification, there were 10 type I, 16 type II, and 6 type III fractures. The treatment was conservative in 8 cases and surgical in 24. The patients were evaluated clinically and radiologically with an average follow-up of 7 years. All patients underwent radiological study at follow-up and 17 underwent NMR evaluation. Eleven underwent NMR evaluation at final follow-up, and the other 6 early in their postoperative evolution. The postoperative results were evaluated based upon clinical and radiological criteria. The clinical result was good or very good in 37.5% of cases. Segmental necrosis of the talar body was noted in 6 cases and complete necrosis in 5, which required arthrodesis in 8 cases. Avascular necrosis is a common complication. Its frequency depends on the type and displacement of the fracture. If it becomes symptomatic, the only treatment is tibiotalar or tibiotalocalcaneal arthrodesis. The contribution of NMR is very important, as it gives the positive diagnosis as well as information regarding evolution. Complete transverse fractures of the talar neck or body are rare; their treatment only gives a little over one third good and very good results in the long term. NMR gives the diagnosis early and shows the extent of necrosis. It can have predictive value for the collapse risk and guide reeducation with or without weight bearing.
作者报告了32例距骨颈或距骨体完全横行骨折的病例系列。这些骨折大多发生在年轻男性身上，由机动车事故所致。骨折线在距骨颈或距骨体处呈横行的有20例，呈矢状的有4例，粉碎性的有8例。采用霍金斯分类法，有10例I型骨折、16例II型骨折和6例III型骨折。8例采用保守治疗，24例采用手术治疗。对患者进行了临床和影像学评估，平均随访7年。所有患者在随访时均接受了影像学检查，17例接受了核磁共振（NMR）评估。11例在最终随访时接受了NMR评估，另外6例在术后早期进行了评估。术后结果根据临床和影像学标准进行评估。37.5%的病例临床结果为良好或非常好。6例出现距骨体节段性坏死，5例出现完全坏死，其中8例需要进行关节融合术。缺血性坏死是一种常见的并发症。其发生率取决于骨折的类型和移位情况。如果出现症状，唯一的治疗方法是胫距或胫距跟关节融合术。NMR的作用非常重要，因为它能做出阳性诊断并提供有关病情发展的信息。距骨颈或距骨体完全横行骨折很少见；从长期来看，其治疗效果仅有略超过三分之一的病例为良好和非常好。NMR能早期做出诊断并显示坏死范围。它对塌陷风险可能具有预测价值，并能指导负重或不负重的康复训练。
