Department of Trauma and Reconstructive Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Foot Ankle Int. 2012 Apr;33(4):359-62. doi: 10.3113/FAI.2012.0359.
Secondary anatomical reconstruction of malunions or nonunions after talar fractures or fracture-dislocations with preservation of all three joints aims at maximal functional rehabilitation. A corrective osteotmy or revision of a pseudoarthrosis with axial realignment and internal fixation was carried out in 22 patients (aged 15 to 50) at a mean of 9 (range, 1.5 to 45) months after having sustained a fracture of the talar head, neck or body. 20 patients were followed for a mean of 4.8 (range, 1.5 to 14) years after reconstruction. No signs of development or progression of avascular necrosis (AVN) were observed in any case. Some amount of progression of peritalar arthritis was seen in 12 of 20 patients (60%). One patient required ankle fusion 7.5 years after reconstruction, another patient needed talo-navicular fusion after 5 years, and a third required a two-stage fusion of the ankle and the subtalar joint after 18 months. Two patients underwent arthrolysis of the ankle and screw removal after 7 and 14 years for dorsiflexion deficit at the ankle. The mean AOFAS ankle/hindfoot score increased from 36.9 preoperatively to 87.5 after correction (p < 0.001). Secondary correction after talar fractures appears promising in active and compliant patients without symptomatic arthritis, with good bone stock, no or partial AVN (less than one-third of the talar body), and no infection. Late fusion with a well-aligned talus remains a salvage option in cases of progressive arthritis.
继发于距骨骨折或骨折脱位的畸形愈合或不愈合的解剖再重建旨在实现最大程度的功能康复。对 22 例患者（年龄 15 岁至 50 岁）在距骨头部、颈部或体部骨折后平均 9（范围 1.5 至 45）个月时进行了矫正性截骨术或假关节的修正，以实现轴向对线和内固定的再重建。20 例患者在重建后平均随访 4.8（范围 1.5 至 14）年。在任何情况下均未观察到缺血性坏死（AVN）的发展或进展迹象。在 20 例患者中有 12 例（60％）可见一定程度的距下关节炎进展。1 例患者在重建后 7.5 年需要进行踝关节融合，另 1 例患者在 5 年后需要进行距舟关节融合，还有 1 例患者在 18 个月后需要进行踝关节和距下关节的两阶段融合。2 例患者在术后 7 年和 14 年因踝关节背屈受限而进行了踝关节松解和螺钉取出术。AOFAS 踝/后足评分从术前的 36.9 分增加到矫正后的 87.5 分（p <0.001）。在没有症状性关节炎、骨质良好、无或部分 AVN（小于距骨体的三分之一）且无感染的活跃且依从性良好的患者中，继发于距骨骨折的矫正似乎很有前途。对于进展性关节炎，晚期融合具有良好对线的距骨仍然是一种挽救选择。
