Cronier Patrick, Talha Abdelhafid, Massin Philippe
Trauma Unit, Osseous Surgery Department, University Hospital, Angers, France.
Injury. 2004 Sep;35 Suppl 2:SB10-22. doi: 10.1016/j.injury.2004.07.009.
Talar fractures are rare and often have to be treated in the emergency department by young surgeons. Thus, important literature series, often multicentric, are generally of little interest regarding practical technical considerations. The aim of this paper is to lead the surgeon who has to treat such fractures to reflect on the goals of the treatment and the means to success. There is probably no better example than talar fractures for the application of the four AO basic principles: Anatomical reduction, stable internal fixation, preservation of the blood supply, and early active pain-free motion. After presenting the different approaches to the talus, the blood supply is described precisely, in reference to the surgical exposures. Then the many tools (tricks) to achieve the treatment goals, avoiding dangers and pitfalls, are meticulously described. Some of the goals, pitfalls, and tools are obvious, whereas some are not, but they could be just as important, if not more so.
距骨骨折较为罕见，年轻外科医生常在急诊科对其进行治疗。因此，重要的文献系列（通常是多中心的）在实际技术考量方面往往价值不大。本文旨在引导必须治疗此类骨折的外科医生思考治疗目标及成功的方法。对于应用AO四大基本原则：解剖复位、稳定内固定、保留血供以及早期无痛主动活动而言，恐怕没有比距骨骨折更好的例子了。在介绍了距骨的不同入路后，结合手术暴露精确描述了血供情况。然后详细阐述了实现治疗目标、避免危险和陷阱的诸多方法（技巧）。其中一些目标、陷阱和方法显而易见，而有些则不然，但即便重要性相当，它们也可能同样重要，甚至更重要。
