HawkinsIII型距骨颈骨折内、外双侧切口联合空心拉力螺钉内固定急诊治疗的应用【摘要】目的：探讨内、外双侧切口联合空心拉力螺钉内固定急诊治疗HawkinsIII型距骨颈骨折的临床疗效。方法：回顾性分析2009年1月-2013年12月急诊手术治疗的41例HawkinsIII型距骨颈骨折患者的临床资料。所有患者均急诊给予内、外双侧切口显露进行骨折复位，联合空心拉力螺钉内固定；术后进行随访，采用美国足与踝关节外科协会（A0FAS）制定的踝与后足功能评分系统评价术前及术后功能。结果：41例患者骨折平均愈合时间（4・2±0・6）个月，无骨折不愈合。平均随访时间（37.8±8.3）个月，末次随访时AQFAS功能评分高于治疗前，比较差异有统计学意义（P=0.027）,疗效评价中11例为优，17例为良，11例为可，另2例为差，优良率达68.3%o18例（43.9%）患者发生创伤性关节炎,7例（17.1%）发生不同程度距骨缺血性坏死。结论：采用内、外双侧切口显露进行骨折复位，联合空心拉力螺钉内固定急诊治疗HawkinsIII型距骨颈骨折的疗效较满意，应依据距骨体移位的特征进行解剖复位，术中需注意保护残存的血运，术后需遵循早运动晚负重的原则进行功能康复锻炼。【关键词】距骨颈骨折；内固定；双切口；空心拉力螺钉ApplicationofInternalandLateralBilateralIncisionsCombinedwithHollowLagScrewFixationintheEmergentTreatmentofHawkinsITTTalusNeckFracture/ZHANShi-ben,MAT[Abstract]Objective：Tointernalandlateralbilateralscrewfixationintheemergentfracture.Method:TheclinicalinvestigatetheclinicaleffectofincisionscombinedwithhollowlagtreatmentofHawkinsIITtalusneckdataof41patientswhoreceivedHong-fei.//MedicalInnovationofChina,2015,12(24)：122-125emergenttreatmentforHawkinsIIItalusneckfractureinourhospitalfromJanuary2009toDecember2013werecollected.Allthepatientsweregiventhetreatment,ofinternalandlateralbilateralincisionscombinedwithhollowlagscrewfixation•卩ostoperativefollowupwasgiventothepatients,thefunctionbeforeandafterthetreatmentwasevaluatedbythescoringsystemofankleandhindfootfunctionwhichwasformulatedbyAOFAS.Result：Theaveragehealingtimewas(4.2+0.6)months,therewasnopatientswithoutfracturehealing.Theaveragedurationoffoilow-upwas(37.8±8.3)months.TheaverageAOFASscoreofthefinalfollowupwashigherthanbeforetreatmenl,thedifferencewasstatisticallysignifiednt(卩二0.027).Therewere11patientswithexcel1entresults,17patientswithgoodresults,11patientswithfairresultsand2patientswithpoorresults，theexcellentandgoodratewas68.3%.Traumaticarthritisoccurredin18patients(43.9%)andavascularnecrosisoccurredin7patients(17.1%).Conelusion：TheeffectofinternalandlateralbilateralincisionscombinedwithhollowlagscrewfixationinlhetreatmentofIlawkinsIIItalusneckfractureissatisfactory.Anatomicalreductionshallbeconductedaccordingtothedisplacementfeaturesoftalus・Theremainingbloodsupplyshal1beprotectedduringtheoperation.Aftertheoperation,patientsshalltakefunctionalrehabilitationexerciseaccordingtotheprincipleofearlyexerciseandlateweight-bearing.[Keywords]Talusneckfracture；Internalfixation；Twoincisions；HollowlagscrewFirst-author'saddress：ThePeople'sHospitalofQionghaiCity,Qionghai571400,Chinadoi：10.3969/j.issn.1674-4985.2015.24.045如今随着交通事故及工伤的增多，临床上收治的距骨颈骨折患者也呈上升趋势，发生率占足骨折的1.5%〜3.0%,多为青壮年男性患者[1]。HawkinsIIT.IV型距骨颈骨折多是高能量的损伤导致，使趴骨体从踝穴完全脱出，踝周软组织（包括神经、血管、肌腱及皮肤等）遭到严重压迫，闭合复位较困难，口手术治疗后仍可能发生相关严重的并发症（如缺血性骨坏死及创伤性关节炎等）⑵。在治疗方式上，因HawkinsITim骨折的发病率（26.1%）要高于IV型骨折（3.6%）,HawkinsIII型...