目的 回顾性分析经皮后外侧人路螺钉内固定手术方式治疗距骨颈骨折的临床疗效.方法 2008年6月～2010年10月对收治的21例距骨颈骨折患者,在X线透视下采用经皮后外侧人路螺钉内固定手术治疗,全部病例获得10～24个月随访(平均18个月).观察手术时间、手术切口长度、术中出血量、住院时间、术后伤口愈合、骨折愈合及内固定情况,同时按Olerud和Molander踝关节骨折术后评分系统对踝关节功能进行评估.结果 手术时间48～80min(平均64min),手术切口长度0.5～1.5cm(平均1cm),术中出血量5～20ml(平均10ml),住院时间3～7天(平均4.5天),所有病例伤口均无裂开、坏死、感染,未见足部感觉麻木和运动功能障碍.术后4～6个月X线片示骨折均愈合,平均4.7个月,无内固定松动,断裂.按Olerud和Molander踝关节骨折术后功能评分平均为87.5分,优良率为83.3％.结论 距骨颈骨折经皮后外侧入路螺钉内固定是一个微创的手术方法,具有对距骨血供影响小,骨折愈合率高,并发症少,术后恢复快,患者功能恢复良好等优点.%Objective To analyze the clinical results of posterolateral approach with screw fixation for talar neck fracture retrospectively. Methods From June 2008 to October 2010,21 patients with talar neck fracture were operated by implanting two percutaneous paralleled screws from posterolateral of ankle under the X ray. All cases were evaluated according to Olemd and Molander scoring system which for ankle functions,and followed up for 10 to 24 months (average 18months). The operation time,the length of incision,the blood loss, the hospital stay,the wound healing, the fracture healing and the fixation conditions were observed. Results The operation time was 48 -80mins(average 64mins) ,the length of incision was 0.5 - 1.5cm (average 1.5cm),the blood loss was 5 -20ml(average 10ml) ,the hospital stay was 3 -7day( average 4. 5 day) ,all cases healed well,no wound infection and no internal fixation loosed. X - ray film showed that all fractures healed in 4 - 6 months, with mean time of 4.7months. All cases were evaluated according to Olemd and Molander scoring system and mean score was 87.5. The ratio of excellent was 83.3% . Conclusion Percutaneous posterolateral screw fixation to treat talus neck fracture is a minimally invasive surgery, with the advantages of little effect on the blood supply of talus, high fracture healing rate, less complications, quick recovery and a good ankle function.
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