Smith Carla S, Nork Sean E, Sangeorzan Bruce J
The Orthopaedic and Neurosurgical Center of the Cascades, 2200 Neff Road, Suite 200, Bend, OR 97701, USA.
J Bone Joint Surg Am. 2006 Nov;88(11):2418-24. doi: 10.2106/JBJS.E.00471.
There is considerable debate regarding the appropriate treatment of the extruded talus regardless of the presence of a fracture. The purpose of this study was to report the clinical results, complications, and functional outcome following reimplantation of the traumatically extruded talus.
A database of 119 patients with an open injury of the talus occurring between 1995 and 2003 at a level-I trauma center was reviewed to identify patients with a complete talar extrusion. Demographic, imaging, and treatment data were obtained from a review of the medical records. Follow-up was undertaken during clinic visits or by telephone. Preoperative and follow-up radiographs were reviewed to identify posttraumatic arthritis, osteonecrosis, or talar collapse, and the Musculoskeletal Functional Assessment was used to assess functional outcome.
Twenty-seven patients were identified. A minimum follow-up of one year (average, forty-two months) was obtained for nineteen patients. Infection and the need for a secondary surgical procedure were the primary determinants of clinical outcome. Two of the nineteen patients had documented infections: one had developed at two weeks and one, after a calcaneal osteotomy at nineteen months. Twelve patients had no subsequent surgery, and seven had subsequent procedures (range, one to four procedures). No patient underwent a delayed amputation. The average Musculoskeletal Functional Assessment score at the time of follow-up was 29.8 (range, 5 to 59). With the numbers studied, no association was found between functional outcome and the following variables: ipsilateral lower-extremity injury, associated talar fracture, secondary procedures, osteonecrosis, or age.
While functional outcome is difficult to assess, salvage of the extruded talus appears to be a relatively safe operation, with a minimal risk of infection, which allows maximal flexibility in aftercare by preserving the most normal ankle anatomy possible.
对于脱位距骨（无论有无骨折）的恰当治疗方法，存在大量争议。本研究的目的是报告创伤性脱位距骨再植入后的临床结果、并发症及功能转归。
回顾了1995年至2003年在一级创伤中心发生开放性距骨损伤的119例患者的数据库，以确定完全性距骨脱位患者。通过查阅病历获取人口统计学、影像学及治疗数据。通过门诊就诊或电话进行随访。复查术前及随访时的X线片以确定创伤后关节炎、骨坏死或距骨塌陷情况，并采用肌肉骨骼功能评估来评定功能转归。
确定了27例患者。19例患者获得了至少一年（平均42个月）的随访。感染及二次手术需求是临床结果的主要决定因素。19例患者中有2例记录有感染：1例在两周时发生，1例在19个月时行跟骨截骨术后发生。12例患者未进行后续手术，7例进行了后续手术（范围为1至4次手术）。无患者接受延期截肢。随访时肌肉骨骼功能评估的平均评分为29.8（范围为5至59）。根据所研究的病例数，未发现功能转归与以下变量之间存在关联：同侧下肢损伤、合并距骨骨折、二次手术、骨坏死或年龄。
虽然功能转归难以评估，但脱位距骨的挽救手术似乎是一种相对安全的手术，感染风险最小，通过尽可能保留最正常的踝关节解剖结构，为术后护理提供了最大的灵活性。
