Parmeshwar Siddharath Sharanappa, Sharma Shyoji Lal, Sharma Arun, Shetty Abhijit, B M Kiran, Patil Siddanagouda
Department of Orthopaedics, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
Department of Orthopaedics, SMS Medical College, Jaipur, Rajasthan, India.
J Clin Orthop Trauma. 2022 Dec 30;37:102092. doi: 10.1016/j.jcot.2022.102092. eCollection 2023 Feb.
The primary objective of this study was to observe and compare the radiographic and clinical outcomes among three different approaches which are anteromedial, anterolateral and combined approach in patients of talar neck fractures. The secondary objective was to observe various complications.
A total of 30 patients underwent open reduction and internal fixation (ORIF) from September 2018 to march 2020 were selected retrospectively. 10 patients were there in each group. Talar neck fractures were classified according to Hawkins classification. All patients underwent ORIF with 4 mm Herbert screws. The follow-up examination included radiological evaluation, clinical and functional outcomes according to American Orthopaedic Foot and Ankle Society hind-foot score (AOFAS).
30 patients were followed up for an average of 20.85 months (range 16-24). The mean time to bony union was 17.25 weeks, 17.35 weeks and 15.92 weeks in groups operated with anteromedial approach, anterolateral approach and combined approach respectively. The mean AOFAS hind-foot score was 76.34, 77.16 and 78.34 at 18th month follow-up in all three groups respectively. In each group, 1 patient had deep wound infection and 2 patients had superficial wound infection. Subtalar arthritis was the most common complication.
There is no significant difference between the three groups in terms of AOFAS hind-foot score, further combined approach provides better visualization of talus fractures and early bony union but it takes longer duration of surgery with increased post-operative complications in comparison with other two groups.
本研究的主要目的是观察和比较距骨颈骨折患者采用三种不同入路（即前内侧入路、前外侧入路和联合入路）后的影像学和临床结果。次要目的是观察各种并发症。
回顾性选取2018年9月至2020年3月期间共30例行切开复位内固定术（ORIF）的患者。每组10例。距骨颈骨折根据霍金斯分类法进行分类。所有患者均采用4毫米Herbert螺钉进行ORIF。随访检查包括影像学评估、根据美国矫形足踝协会后足评分（AOFAS）评估的临床和功能结果。
30例患者平均随访20.85个月（范围16 - 24个月）。分别采用前内侧入路、前外侧入路和联合入路手术治疗的三组患者，其平均骨愈合时间分别为17.25周、17.35周和15.92周。在第18个月随访时，三组患者的平均AOFAS后足评分分别为76.34、77.16和78.34。每组均有1例患者发生深部伤口感染，2例患者发生浅表伤口感染。距下关节炎是最常见的并发症。
三组患者在AOFAS后足评分方面无显著差异，进一步的联合入路能更好地显露距骨骨折并实现早期骨愈合，但与其他两组相比，手术时间更长，术后并发症增加。
