距骨骨折伴距下关节脱位1例报告及距骨骨折缺血性坏死与手术入路关系的探讨

Report of a Case of Talar Fracture with Subtalar Joint Dislocation and the Relationship between Avascular Necrosis of Talar Fracture and Surgical Approach

摘要: 距骨骨折在足踝部创伤中并不多见，而合并脱位则更为少见，往往会导致距骨血供中断，若处理不当容易造成距骨坏死、创伤性关节炎等并发症。距骨骨折后缺血性坏死(Avascular Necrosis后称AVN)是临床常见且严重的并发症，其发生与骨折分型、手术入路选择及复位质量密切相关。本文结合Hawkins分型及国内外研究进展，系统探讨不同手术入路对距骨缺血性坏死的影响，提出基于解剖重建和血管保护的个体化治疗策略，为临床决策提供参考。

Abstract: Talar fracture is rare in foot and ankle trauma, and combined dislocation is even rarer, which often leads to disruption of talar blood supply, and is prone to complications such as talar necrosis and traumatic arthritis if not treated properly. Avascular necrosis after talar fracture is a common and serious clinical complication, and its occurrence is closely related to fracture typing, choice of surgical approach, and quality of reduction. In this paper, we systematically discuss the effects of different surgical approaches on talar necrosis in the light of Hawkins’ typing and the progress of domestic and international research, and propose an individualized treatment strategy based on anatomical reconstruction and vascular protection, which will provide a reference for clinical decision-making.