Zhang P, Dong Q R, Wang Z Y, Chen B, Wan J H, Wang L
Department of Orthopaedics, Suzhou Science & Technology Town Hospital, Suzhou 215153, China.
Zhonghua Yi Xue Za Zhi. 2016 Nov 8;96(41):3342-3346. doi: 10.3760/cma.j.issn.0376-2491.2016.41.014.
To explore the manual operation skills of operative treatment of ipsilateral Hawkins Ⅲ talus neck and ankle joint fractures via internal and lateral approaches with Herbert screws, and to study the clinical results. From Jan 2009 to Dec 2014, the clinical data of 13 patients with ipsilateral Hawkins Ⅲ talus neck and ankle joint fractres via internal and lateral approaches with Herbert screws were retrospectively analyzed in our department.There were 10 males and 3 female, ranging in age from 20 to 60 years with an average age of 31.5 years.The fractures occurred on the right side in 9 patients and on the left side in 4 patients.Three cases had the complication of medial malleolar fracture.Ten cases had the complication of medial and lateral malleolar fracture. Totally 11 cases were made calcaneal skeletal traction, and all the were made CT with three-dimensional image reconstruction.Two cases were treated with emergency operation.Eleven cases were treated with selective operation.The operation time was 5 hours-10 days after injury. The functional results were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS). The average duration of follow-up was 22.6 months (range, 14-65 months). There was skin necrosis in one cases, no incision infection, malunion and nonunion of the fractures and loss of reduction. At final follow-up, AOFAS ankle score was 75.2 (range, 42 to 93), higher than preoperative 39.2 (range, 23 to 60), the difference was statistically significant (=0.023). The result was excellent in 4 cases, good in 5 cases, fair in 3 cases and 1 cases in poor, and the overall excellent or good rate was 69.2%. Avascular necrosis occurred in 3 cases (23.1%, 3/13). Traumatic arthritis was found in 5 cases (38.5%, 5/13), involved tibial astragaloid joint in 2 cases, involved subtalar joint in 1 case, involved tibial astragaloid joint and subtalar joint in 2 cases. The effect of surgical treatment for ipsilateral Hawkins Ⅲ talus neck and ankle joint fractures via internal and lateral approaches with Herbert screws is satisfactory.Correct operative approach and pay more attention to protect blood circulation of intraoperative, anatomical precision and strong reduction and fixation are the key to achieve and gain better long-term results for the surgical treatment of ipsilateral Hawkins Ⅲ talus neck and ankle joint fractures.
探讨采用Herbert螺钉经内外侧入路手术治疗同侧HawkinsⅢ型距骨颈骨折合并踝关节骨折的手术操作技巧，并研究其临床疗效。回顾性分析2009年1月至2014年12月我科收治的13例采用Herbert螺钉经内外侧入路治疗的同侧HawkinsⅢ型距骨颈骨折合并踝关节骨折患者的临床资料。其中男10例，女3例，年龄20～60岁，平均31.5岁。骨折发生于右侧9例，左侧4例。3例合并内踝骨折，10例合并内外踝骨折。11例均行跟骨骨牵引，均行CT三维重建。2例行急诊手术，11例行择期手术。手术时间为伤后5小时～10天。采用美国矫形足踝协会（AOFAS）评分评价功能结果。平均随访时间22.6个月（14～65个月）。1例发生皮肤坏死，无切口感染、骨折畸形愈合、不愈合及复位丢失。末次随访时，AOFAS踝关节评分为75.2分（42～93分），高于术前39.2分（23～60分），差异有统计学意义（P=0.023）。优4例，良5例，可3例，差1例，优良率69.2%。3例发生缺血性坏死（23.1%，3/13）。5例发生创伤性关节炎（38.5%，5/13），其中累及胫距关节2例，距下关节1例，胫距关节和距下关节2例。采用Herbert螺钉经内外侧入路手术治疗同侧HawkinsⅢ型距骨颈骨折合并踝关节骨折疗效满意。正确的手术入路，术中注意保护血运、解剖精确、坚强复位固定是同侧HawkinsⅢ型距骨颈骨折合并踝关节骨折手术治疗获得良好远期效果的关键。
