Veselý R, Kelbl M, Kacián J, Hulka V, Kočiš J, Kunovský R
Úrazová nemocnice v Brně, Klinika traumatologie Lékařské fakulty Masarykovy univerzity Brno.
Acta Chir Orthop Traumatol Cech. 2017;84(2):120-124.
PURPOSE OF THE STUDY Closed reduction and percutaneous fixation of nondisplaced talar neck fractures have been applied by some authors. The aim of this paper is to assess the results and complications of this minimally invasive technique. MATERIAL AND METHODS In the period from 2009 to 2014, twenty-one patients with a talar neck fracture were observed after closed reduction and percutaneous screw fixation in the Traumatological Hospital in Brno. The mean age of the patients was 38 years (range 18-56 years). The mechanism of injury was a motor vehicle accident in 11 cases, a fall from height in six cases, a sports injury in 3 cases, and a fall from stairs in one case. Injuries were classified according to the Hawkins classification. Conventional preoperative 3-dimensional CT scans of the fractures were analysed. Under the guidance of C-arm fluoroscopy, Kirscher wires were used for closed reduction and temporary percutaneous fixation. Subsequently, 3.5 and 4.5 mm diameter cannulated screws were inserted. The outcome was evaluated on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale. RESULTS The average follow-up was 32 months (21-42 months). The average healing time was 15.5 weeks (13-19 weeks). The average AOFAS score was 82.3 points (69-96 points). 75% of patients with type I injury achieved excellent results and 72% of patients with type II injury achieved excellent or good results. None of the patients developed wound complications. Two patients developed partial avascular necrosis and three patients subtalar traumatic arthritis after surgery. DISCUSSION Talar neck fractures are relatively uncommon fractures. Most of the published studies are small. Tenuous blood supply and displaced talar neck fracture predispose to avascular necrosis of the talus. Closed reduction and percutaneous fixation can reduce the soft tissue damage and disturbance to the blood supply. CONCLUSIONS Preoperative 3D CT scans, early surgery, anatomic articular surface reduction and percutaneous screw fixation increase the fracture healing rate and reduce the incidence of talar avascular necrosis. Key word: talus, closed reduction, percutaneous fixation, screw.
研究目的 一些作者采用了闭合复位及经皮固定治疗无移位距骨颈骨折。本文旨在评估这种微创技术的结果及并发症。材料与方法 2009年至2014年期间，在布尔诺创伤医院对21例距骨颈骨折患者进行了闭合复位及经皮螺钉固定治疗后进行观察。患者平均年龄38岁（范围18 - 56岁）。损伤机制为机动车事故11例、高处坠落6例、运动损伤3例、楼梯坠落1例。损伤根据Hawkins分类法进行分类。对骨折常规术前三维CT扫描进行分析。在C形臂荧光透视引导下，使用克氏针进行闭合复位及临时经皮固定。随后，插入直径3.5和4.5毫米的空心螺钉。结果根据美国矫形足踝协会（AOFAS）评分量表进行评估。结果 平均随访32个月（21 - 42个月）。平均愈合时间为15.5周（13 - 19周）。平均AOFAS评分为82.3分（69 - 96分）。I型损伤患者75%获得优异结果，II型损伤患者72%获得优异或良好结果。无患者发生伤口并发症。术后2例患者发生部分缺血性坏死，3例患者发生距下创伤性关节炎。讨论 距骨颈骨折相对不常见。大多数已发表的研究规模较小。距骨血供薄弱及距骨颈骨折移位易导致距骨缺血性坏死。闭合复位及经皮固定可减少软组织损伤及对血供的干扰。结论 术前三维CT扫描、早期手术、解剖复位关节面及经皮螺钉固定可提高骨折愈合率并降低距骨缺血性坏死的发生率。关键词：距骨、闭合复位、经皮固定、螺钉
