Wagener J, Schweizer C, Zwicky L, Horn Lang T, Hintermann B
Clinic of Orthopaedic Surgery, Kantonsspital Baselland, CH-4101 Bruderholz, Switzerland.
Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
Bone Joint J. 2018 Apr 1;100-B(4):461-467. doi: 10.1302/0301-620X.100B4.BJJ-2017-0772.R3.
Arthroscopically controlled fracture reduction in combination with percutaneous screw fixation may be an alternative approach to open surgery to treat talar neck fractures. The purpose of this study was thus to present preliminary results on arthroscopically reduced talar neck fractures.
A total of seven consecutive patients (four women and three men, mean age 39 years (19 to 61)) underwent attempted surgical treatment of a closed Hawkins type II talar neck fracture using arthroscopically assisted reduction and percutaneous screw fixation. Functional and radiological outcome were assessed using plain radiographs, as well as weight-bearing and non-weight-bearing CT scans as tolerated. Patient satisfaction and pain sensation were also recorded.
Primary reduction was obtained arthroscopically in all but one patient, for whom an interposed fracture fragment had to be removed through a small arthrotomy to permit anatomical reduction. The quality of arthroscopic reduction and restoration of the talar geometry was excellent in the remaining six patients. There were no signs of talar avascular necrosis or subtalar degeneration in any of the patients. In the whole series, the functional outcome was excellent in five patients but restricted ankle movement was observed in two patients. All patients had a reduction in subtalar movement. At final follow-up, all patients were satisfied and all but one patient were pain free.
Arthroscopically assisted reduction and fixation of talar neck fractures was found to be a feasible treatment option and allowed early functional rehabilitation. Cite this article: Bone Joint J 2018;100-B:461-7.
关节镜控制下骨折复位联合经皮螺钉固定可能是治疗距骨颈骨折的一种替代开放手术的方法。因此，本研究的目的是展示关节镜下复位距骨颈骨折的初步结果。
共有7例连续患者（4例女性，3例男性，平均年龄39岁（19至61岁））接受了尝试性手术治疗，采用关节镜辅助复位和经皮螺钉固定治疗闭合性Hawkins II型距骨颈骨折。使用X线平片以及在耐受情况下进行负重和非负重CT扫描评估功能和影像学结果。还记录了患者满意度和疼痛感觉。
除1例患者外，所有患者均通过关节镜实现了初次复位，该例患者必须通过小切口切开术取出嵌入的骨折碎片以实现解剖复位。其余6例患者的关节镜复位质量和距骨几何形状的恢复情况极佳。所有患者均未出现距骨缺血性坏死或距下关节退变的迹象。在整个系列中，5例患者的功能结果极佳，但2例患者观察到踝关节活动受限。所有患者的距下关节活动均减少。在最终随访时，所有患者均表示满意，除1例患者外均无疼痛。
关节镜辅助复位和固定距骨颈骨折被认为是一种可行的治疗选择，并允许早期功能康复。引用本文：《骨与关节杂志》2018年；100 - B：461 - 467。
