Palomo-Traver J M, Cruz-Renovell E, Granell-Beltran V, Monzonís-García J
Servico Traumatología y Cirugía Ortopédica Hospital, Castelló, Spain.
J Orthop Trauma. 1997 Jan;11(1):45-9. doi: 10.1097/00005131-199701000-00014.
An open pure total lateral dislocation of the right talus with extrusion of the whole talar body is reported. Immediately surgical debridement, reduction, and primary closure were accomplished under antibiotic coverage. The ankle was immobilized for 6 weeks, and weight-bearing was restricted for 6 more weeks. Neither avascular necrosis (AVN) of the talus nor infection developed. Both ankle and foot regained full pain-free range of motion at 16 weeks, except for a mild restriction of the last 5 degrees of supination. Four years postinjury, the patient continues in the same preinjury occupation. A thorough review of the literature suggested that (a) immediate closed or open reduction is preferable; (b) if AVN develops, it can be treated in most cases by weight-bearing restrictions; and (c) talectomy, alone or associated with a tibiocalcaneal arthrodesis, should be reserved for an eventual reconstructive procedure, particularly in the event of talus infection.
本文报告了一例右侧距骨开放性完全外侧脱位，伴有整个距骨体挤出的病例。在抗生素覆盖下，立即进行了手术清创、复位和一期缝合。踝关节固定6周，负重再限制6周。未发生距骨缺血性坏死（AVN）或感染。16周时，踝关节和足部均恢复了完全无痛的活动范围，除了旋后最后5度有轻度受限。受伤四年后，患者继续从事伤前的职业。对文献的全面回顾表明：（a）立即进行闭合或开放复位是可取的；（b）如果发生AVN，大多数情况下可通过限制负重进行治疗；（c）距骨切除术，单独或与胫跟关节融合术联合应用，应留作最终的重建手术，特别是在距骨感染的情况下。
