Jarde O, Trinquier-Lautard J L, Mertl P, Tran Van F, Vives P
Service d' Orthopédie-Traumatologie, Centre Hospitalier Universitaire Nord, Amiens.
Rev Chir Orthop Reparatrice Appar Mot. 1996;82(1):42-48.
The subtalar dislocation is a rare injury. The authors appreciate the difference of frequency between medial and lateral displacement, the factors likely to increase a classical favorable prognosis and the therapeutic attitude to suggest.
35 observations were included of which two bilateral, 26 had a medial displacement, 9 a lateral displacement. Treatment was conservative in 21 cases and surgical in 14 cases. The results were analysed using Gay and Evrard's clinical scoring system at which we added radiological results.
The average follow-up was 7 years and 7 months. The global results are 11 excellent, 13 good, 9 fair, 2 poor.
The high frequency of medial displacement is explained by the fact that the subtalar joint is only really unstable in inversion. The lateral displacement is rare. The prognosis is good in pure dislocation. It is only good enough every time a fragmentary talar fracture is associated as a factor of stiffness. The 11 arthrosis cases are secondary to a dislocation associated with a talar dislocation, a scaphoid dislocation or a vascular injury. In the series, there is no syndrome of tarsal sinus, and no post traumatic instability. Talar necrosis are rare: 3 cases in this series. They occur following large dislocations at the limit of enucleation. The reduction is urgent. The treatment is more often conservative. It must be surgical in case of associated injury requiring a surgical procedure or in front of widely open dislocation.
Subtalar dislocation is a rare injury. In the majority of cases, the displacement is medial. The prognosis is good in pure cases. It's only good enough every time a fragmentary talar fracture is associated as a factor of joint stiffness.
距下关节脱位是一种罕见的损伤。作者了解内侧和外侧移位的频率差异、可能增加典型良好预后的因素以及建议的治疗态度。
纳入35例观察病例，其中2例为双侧病例，26例为内侧移位，9例为外侧移位。21例采用保守治疗，14例采用手术治疗。使用盖伊和埃弗拉德的临床评分系统分析结果，并在此基础上增加了放射学结果。
平均随访时间为7年7个月。总体结果为11例优，13例良，9例可，2例差。
内侧移位频率高的原因是距下关节仅在旋后时才真正不稳定。外侧移位很少见。单纯脱位的预后良好。只有当伴有距骨骨折碎片作为僵硬因素时，预后才足够好。11例关节病病例继发于与距骨脱位、舟骨脱位或血管损伤相关的脱位。在该系列中，没有跗骨窦综合征，也没有创伤后不稳定。距骨坏死很少见：本系列中有3例。它们发生在接近摘除极限的大脱位之后。复位是紧急的。治疗通常更倾向于保守治疗。如果伴有需要手术的损伤或面对广泛开放性脱位，则必须进行手术治疗。
距下关节脱位是一种罕见的损伤。在大多数情况下，移位是内侧的。单纯病例的预后良好。只有当伴有距骨骨折碎片作为关节僵硬因素时，预后才足够好。
