| 距骨体剪力骨折和粉碎骨折的治疗分析 |
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投稿时间：2009-12-03
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| 作者 | Author | 单位 | Address | E-Mail |
| 胡新永 |
HU Xin-yong |
清华大学玉泉医院骨科，北京 100049 |
Department of Orthopaedics,the General Hospital of PLA,Beijing 100853,China |
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| 吕原 |
Lü Yuan |
清华大学玉泉医院骨科，北京 100049 |
Department of Orthopaedics,the General Hospital of PLA,Beijing 100853,China |
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| 杨华清 |
YANG Hua-qing |
清华大学玉泉医院骨科，北京 100049 |
Department of Orthopaedics,the General Hospital of PLA,Beijing 100853,China |
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| 裴广杰 |
PEI Guang-jie |
清华大学玉泉医院骨科，北京 100049 |
Department of Orthopaedics,the General Hospital of PLA,Beijing 100853,China |
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| 张雪松 |
ZHANG Xue-song |
解放军总医院骨科 |
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zhangxuesong301@sina.com |
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| 期刊信息：《中国骨伤》2010年，第23卷，第3期，第222-224页 |
| DOI：10.3969/j.issn.1003-0034.2010.03.024 |
| 基金项目: |
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中文摘要:
目的：研究距骨体骨折的治疗方法和临床疗效。
方法：自1988年10月至2005年9月，采用石膏外固定、切开复位内固定、胫-距-跟关节融合术治疗34例距骨体剪力骨折和粉碎骨折。男19例，女15例，年龄13～55岁，平均28.8岁。伤后至治疗时间3～14 d,平均6 d.石膏外固定10例，切开复位内固定18例，Ⅰ期Blair胫-距-跟融合术6 例。采用Hawkins评分标准，从疼痛、关节活动度和跛行等方面来评定疗效。
结果：34例均获得随访，时间3～19年，平均5.04年。术后患者伤口均愈合良好。按Hawkins评分标准：优6例，良9例，可11例，差8例。距骨缺血性坏死15例，踝关节炎18例，距下关节炎14例。
结论：移位小于3 mm骨折宜石膏外固定，手法复位后骨折移位大于3 mm应切开复位内固定，关节面不能修复的粉碎骨折宜采用Blair胫-距-跟融合术。距骨体剪力骨折和粉碎骨折预后差。 |
| 【关键词】足损伤 骨折 距骨 关节融合术 |
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| Treatment of shearing-type and comminuted talar body fractures |
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ABSTRACT
Objective: To study the treatment and therapeutic effects in the shearing-type and comminuted talar body fractures.
Methods: From October 1988 to September 2005,34 patients with shearing-type or comminuted talar body fractures were followed up. There were 19 males and 15 females ranged from 13 to 55 years(averaged 28.8 years). The disease course ranged from 3 to 14 days(averaged 6.0 days). Ten patients with a displacement of no more than 3 mm were treated with plastic cast. Eighteen patients were treated with open reduction and internal fixation,6 patients were treated with joint fusion. The assessment of clinical efforts depend on patients' ache,active range of the joint and limp.
Results: The mean follow up was 5.04 years(ranged from 3 to 19 years). All the patients were healed. The clinical outcomes were evaluated according to Hawkins evaluation score in which ache, active range of the joint and limp was respectively acssessed. There were 6 patients reached an excellent result,9 good,11 fair and 8 poor. Fifteen patients had osteonecrosis,18 patients had traumatic arthritis of ankle joint,and 14 patients had traumatic arthritis of subtalar joint.
Conclusion: Patients whose displacement of fracture is not more than 3 mm should be treated with plastic cast. Operation and internal fixation should be performed in patients whose displacement of fracture is more than 3 mm after close reduction. Joint fusion should be performed in patients whose talar body fracture is comminuted severely and the surface of joint can not be repaired. The patients of talar body scissored fracture or comminuted fracture has bad prognosis. |
| KEY WORDS Foot injuries Fractures Talus Arthrodesis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 胡新永,吕原,杨华清,裴广杰,张雪松.距骨体剪力骨折和粉碎骨折的治疗分析[J].中国骨伤,2010,23(3):222~224 |
| 英文格式: | HU Xin-yong,Lü Yuan,YANG Hua-qing,PEI Guang-jie,ZHANG Xue-song.Treatment of shearing-type and comminuted talar body fractures[J].zhongguo gu shang / China J Orthop Trauma ,2010,23(3):222~224 |
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