Frawley P A, Hart J A, Young D A
Orthopaedic Service, Alfred Hospital, Melbourne, Australia.
Foot Ankle Int. 1995 Jun;16(6):339-45. doi: 10.1177/107110079501600605.
Twenty-six patients with major fractures of the talus were studied to assess the long-term outcome. The patients were admitted to a university teaching hospital and major trauma center from 1983 to 1991. The study excluded isolated fractures of the talar dome and posterior tubercle. Fifteen patients were treated using internal fixation and 11 patients were treated using nonsurgical methods. Avascular necrosis was detected in only four of the 26 patients. Subtalar osteoarthritis was a significant problem in 61%. Seven of these patients have come to secondary fusion procedures, with another three contemplating fusion procedures at the time of review. Only one patient developed significant avascular necrosis requiring a fusion procedure. Only three of 26 patients had not returned to work at a mean 6 years after their injury. Eleven of the 26 (42%) had not returned to their premorbid activity level. The majority of these patients (25/26) had sustained multiple injuries, which compromised the functional recovery from the talar injury. Early accurate diagnosis and anatomical reduction gave the best results. The low incidence of avascular necrosis in this study has been attributed to early anatomical stabilization of the fracture. We believe an early CT scan can more accurately assess the severity of the talar fracture and offers the best information for an appropriate treatment plan.
对26例距骨严重骨折患者进行了研究，以评估其长期预后。这些患者于1983年至1991年期间被收治入一所大学教学医院及主要创伤中心。该研究排除了距骨穹窿和后结节的孤立性骨折。15例患者采用内固定治疗，11例患者采用非手术方法治疗。26例患者中仅4例检测出缺血性坏死。距下骨关节炎是61%患者的一个重要问题。其中7例患者已接受二次融合手术，另有3例在复查时考虑进行融合手术。仅1例患者发生严重缺血性坏死，需要进行融合手术。26例患者中仅3例在受伤后平均6年未恢复工作。26例患者中有11例（42%）未恢复到病前的活动水平。这些患者中的大多数（25/26）还受到多处损伤，这影响了距骨损伤后的功能恢复。早期准确诊断和解剖复位可取得最佳效果。本研究中缺血性坏死的低发生率归因于骨折的早期解剖学稳定。我们认为早期CT扫描可以更准确地评估距骨骨折的严重程度，并为制定合适的治疗方案提供最佳信息。
