Internal or external malleolus osteotomy using absorbable screw or absorbable stick for talar fracture: follow-up in 15 cases

doi:10.3969/j.issn.2095-4344.2014.48.018

Abstract

Abstract:

BACKGROUND: Strict requirement of the reduction after talar fracture and susceptibility to blood supply dysfunction in talus are two main problems for the treatment of talar fracture, which is also called two balance points. On one hand, talar fracture needs precise reduction; one the other hand, blood supply in the talus should be protected.
OBJECTIVE: To explore therapeutic effect of internal or external malleolus osteotomy using absorbable screw or absorbable stick for talar fracture.
METHODS: From June 2008 to June 2011, 16 patients of talar fracture were treated with internal or external malleolus osteotomy. The talus was fixed using absorbable screw or absorbable stick, and refixed with steel plate or cannulated screws after reduction of internal or external malleolus. The blood supply should be protected during the operation. Internal incision was derived from the anterior border of medial malleolus to tubercle of scaphoid bone, between tibialis anterior and tibialis posterior muscle, avoiding the great saphenous vein. The rest blood supply of the talus which resided in the triangular ligament area should also be protected. When cleaning bone fragments, the drills and screws should not be close to subtalar joint, avoiding injury in the vascular network
of tarsal sinus and the artery in tarsal tunnel. Based on the patient’s chief complains, clinical efficacy was evaluated through detections of ankle joint appearance and function, X-ray and CT scanning. The therapeutic effect was assessed with Hawkings scoring system.
RESULTS AND CONCLUSION: The involved 15 patients were followed up for 25-36 months. According to the modified Hawkings, 8 patients (53%) were rated as excellent, 5 patients (33%) good, 1 (7%) fair and 1 (7%) poor, the total rate of being excellent and good was 86%. Operation through approach of internal or external malleolus osteotomy using absorbable screw or absorbable stick is a good method for treatment of talar fracture.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: talars, fractures, internal fixators, follow-up studies

CLC Number:

R318

Li Gang-jian, Zhao Xin. Internal or external malleolus osteotomy using absorbable screw or absorbable stick for talar fracture: follow-up in 15 cases[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(48): 7810-7815.

Figures/Tables 2

References

[1] Thomas FH, Michael RB. Diagnosis and treatment of fracture of the talus:a comprehensive review of the literature. Foot Ankle Int.1999;20:595-605.
[2] Rammelt S, Zwipp H. Talar neck and body fractures. Injury. 2009;2:120-135.
[3] 张长青,张伟,主译.骨折手术技巧图解[M].上海:上海科学技术出版社,2011:7357-7371.
[4] 彭湘晖.螺旋CT重建在距骨骨折诊断中的价值[J].华西医学, 2009,14(4): 843-844.
[5] Magid D, Fishman EK. Imaging of muscul osketeal trauma in three dimensions-an integrated two-dimensional/ three-dimensional approach with computed tomography. RCNA.1989;27: 945-956.
[6] Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg ( Am).1970;52: 991.
[7] 卢世璧,主译.坎贝尔骨科手术学[M]. 11版.北京:人民军医出版社, 2009: 55-56.
[8] 卢绍燊,余海波.经内踝截骨空心钉内固定治疗HaokinsII和II型距骨骨折的疗效[J].广东医学,2013,34(2):270-271.
[9] 隋爱萍,孙芬兰,于仙娟.改良前入路治疗复杂踝关节骨折脱位的护理及康复训练指导[J].中医正骨,2012,24(5):66-67.
[10] Fullerson EW,Egol KA. Timing issues in fracture management: a review of current concepts. Bull NYU Hosp Jt Dis. 2009;1: 58-67.
[11] 马睿,舒衡生.距骨颈骨折治疗方法及疗效分析[J].中国矫形外科杂志,2012,20(10):894-896.
[12] 王琨,朱琪.距骨侧位形态分析附175例X线照片及10例足标本观察[J].实用放射学杂志.1998.14(3):618-619.
[13] 黄昌林,丁志海.距骨骨折脱位手术入路的解剖研究与临床应用[J].中华骨科杂志,1994,14(12):736-738.
[14] Crenshaw AH. Campbell 's Orthopaedics. 8thver. Mosby- Year Book,Inc. St Louis, 1992: 2892.
[15] 王荣诗,黄迅,谭伦．距骨颈骨折手术内固定远期疗效观察［J］．中国骨与关节损伤杂志,2012,27(6): 560-561．
[16] Cronier P,Talha A,Massin P. Central talar fractures-therapeutic considerations. Injury. 2004;35( S2):10-22.
[17] 陈勇忠,周清碧,戴晓明,等.经内踝截骨手术人路治疗复杂的距骨骨折[J].广东医学,2006,27(10):1518-1519．
[18] 李京生,李绍光,孙天胜,等.经内外踝截骨入路可吸收螺钉固定治疗复杂距骨体部骨折[J].中国矫形外科杂志,2006,14(10): 749-750.
[19] 黄林昌,崔明华,黄涛,等.距骨骨折脱位手术入路的解剖研究与临床应用[J].中华骨科杂志,1994,14(12): 736-738.
[20] 李祖明.距骨骨折手术疗效的影响因素分析研究[J].当代医学, 2012,18(17):107.
[21] 李元洲,杨茂伟,冯博.距骨血液供应的解剖学研究[J].中国医学工程,2012,20(1):86-88.
[22] Ziran BH,Abidi NA,Scheel MJ.Medial malleolar osteotomy for exposure of complex talar body fractures. J Orthop Trauma. 2001;15(7): 513.
[23] 刘鸿程,邹玉莲,赖优良.经内外踝低位截骨入路治疗复杂距骨骨折脱位[J].中国骨与关节损伤杂志,2011,26(2):185.
[24] Nabil A,Ebraheim VP,Christopher O,et al. Clinical outcomes of fractures of the talar body. Inter Othop. 2008;6:773-777．
[25] 余全胜.距骨颈骨折行闭合复位经皮空心螺钉内固定治疗的临床价值[J].中国伤残医学,2012,20(12):36-37.
[26] Lin S,Hak DJ. Management of talar neck fractures. Orthopedics. 2014;3(90):715-727.
[27] Sproule JA, Glazebrook MA, Younger AS.Varus hindfoot deformity after talar fracture.Foot Ankle Clin. 2012;17(10): 117-125.
[28] 陈学强,俞立新.采用Herbert钉内固定急诊手术治疗距骨骨折也取得较好疗效[J].中国骨与关节损伤杂志,2013,28(2): 186-188.
[29] 胡力,周忠,陈学明,等.内固定结合骨诱导活性材料治疗HawkinsⅡ、Ⅲ型距骨颈骨折[J].创伤外科杂志, 2013, 15(4):331-334.
[30] Ly PN, Falat LM. Transchondral fractures of the talus :A review of 64 surgical cases. Foot Ankle Surg. 1993;4:352.
[31] 张勇,贾斌,曹国庆.可吸收钉结合硫酸钙治疗距骨体粉碎性骨折22例分析[J].中国误诊学杂志,2011,5(11):3746-3747.
[32] 王荣诗,黄迅,谭伦．距骨颈骨折手术内固定远期疗效观察[J]．中国骨与关节损伤杂志,2012,27(6): 560-561．
[33] 刘立峰,蔡锦方,梁进,等.可吸收螺钉固定治疗移位的距骨颈骨折[J].中国修复重建外科杂志,2003,17(5):367-369．
[34] Jukkala PK,Pohjonen T,Laitinen O,et al.Biodegradation and strength retention of poly-L-lactides clews in vivo.An experimental long•term study sheep.Ann Chir Gynaecol. 2001;90(3):219-223．
[35] 王卫国,蔡锦方,曹学成.可吸收螺钉治疗关节部位骨折的临床体会[J].中国骨与关节损伤杂志,2004,19(1):63-65．
[36] Sneppen O,Bunl O.Fracture of the talus.a study of its genesis and morphology.based upon cases with associated ankle fracture. Acta Orthop Scand. 1974;45(2):307-309.
[37] 张驰,顾文奇,施忠民.经外踝截骨锁定钢板固定的胫距跟关节融合术的应用[J].中华创伤骨科杂志,2012,14(4):309-312.
[38] Ohl X,Harisboure A,Hemery X,et al.Long-term follow-up after surgical treatment of talar fractures: twenty cases with an average follow-up of 7.5 years. Int Orthop. 2011;1:93-99.
[39] Vaillier HA,Nork SE,Barei DP,et al.Talar neck fracture: results and outcomes.J Bone Joint Surg Am. 2004;8:1616-1624.
[40] 李泽龙,蔡习炜,刘发平,等.距骨骨折的基础研究及临床治疗进展[J].创伤骨科杂志,2010,12(4):377.
[41] 施忠民,顾文奇,梅国华.双切口接骨板内固定治疗距骨颈粉碎性骨折的临床效果[J].中国骨与关节损伤杂志,2012,5(4): 310-314.
[42] Kely FB Jr. Fracture of the neck of the talus:Long terme-valuation of 71 eases. J Bone Joint Surg(Am).1978; 60(2):143-156.
[43] 杨勇,朱守荣,主译.骨科标准手术技术丛书[M]. 2版,沈阳:辽宁科学技术出版社,2004:469.
[44] 胡畔,何锦泉,张英泽.距骨颈骨折治疗进展[J].中华骨科杂志, 2013, 33(4):419-422.
[45] 刘宏波,田清叶,何正,等.距骨严重骨折脱位的外科治疗[J].山东医药,2013,53(8):67-68.
[46] 王岩,武勇,龚晓峰,等. SneppenII型距骨体骨折的手术技巧及疗效分析[J].中华创伤骨科杂志,2007,9(5):435-437.
[47] Mei-Dan O, Hetsroni I, Mann G, et al. Prevention of avascular necrosis in displanced talar neck fractures by hyperbaric oxygenation therapy; a dual case report. J Postgrad Med. 2008;54(2):140-143.