Lesić Aleksandar R, Zagorac Slavisa G, Bumbasirević Marko Z
University of Belgrade, Faculty of Medicine, Belgrade.
Acta Chir Iugosl. 2012;59(1):25-30.
Injuries of the talus represents an important part of the foot and ankle trauma. Since talar bone connect the lower limb and foot, the sequelas of its trauma could have significant influence on the function of the whole lower limb and gait. The specific vascularization of the talus results in delayed union and even in the avascular necrosis. The diagnosis of the fractures of the talus can be made on the x-rays, but sometimes real picture of the fracture pattern can be seen only in the CT scans. Ocult fractures such as osteochondral fractures and avascular necrosis can be exactly detected on MRI in aim not to be overlookded as the ankle sprain diagnosis. The precise reduction and stable internal fixation is mandatory in the treatment to enable the anatomical position of the talonavicular, talocrural and subtalar joint and to make possible early motion and rehabilitation, without weight bearing. On the other hand, crushed fractures, open fractures and the Hawkins III-IV fractures with the dislocations of the talar body sometimes needs salvage procedures like Blair or tibio-talar or tibio-calcaneal fusion.
距骨损伤是足踝部创伤的重要组成部分。由于距骨连接下肢和足部，其创伤后遗症可能对整个下肢功能和步态产生重大影响。距骨特殊的血供导致愈合延迟，甚至出现缺血性坏死。距骨骨折的诊断可通过X线片作出，但有时骨折类型的真实情况只有在CT扫描中才能看到。隐匿性骨折，如骨软骨骨折和缺血性坏死，可通过MRI准确检测，以免被误诊为踝关节扭伤。治疗中必须进行精确复位和稳定的内固定，以使距舟、距小腿和距下关节恢复解剖位置，并在不负重的情况下实现早期活动和康复。另一方面，粉碎性骨折、开放性骨折以及伴有距骨体脱位的Hawkins III-IV型骨折有时需要采取挽救手术，如Blair手术或胫距或胫跟融合术。
