Оперативне лікування переломів шийки таранної кістки (ранні результати)

Abstract

Обоснована проблема лечения переломов шейки таранной кости. Представлены особенности и техника применения оригинального устройства при лечении пациентов с переломами рассматриваемой локализации. Разработанная в клинике методика стержневой управляемой фиксации апробирована у двух пациентов мужского пола в возрасте 27 и 36 лет. Аппарат позволяет выполнить управляемую репозицию и стабильную фиксацию отломков таранной кости до сращения, сохраняя при этом функцию голеностопного сустава. Проведен анализ ранних исходов лечения у всех пациентов в 6 и 10 мес. после операции. Оценка результатов восстановления анатомии и функции стопы показала, что адекватная и оптимальная хирургическая техника позволила избежать осложнений, восстановить функцию стопы практически до уровня нормы и получить положительные клинические результаты (92 бала по AOFAS; 5,5 баллов по FFI).

The consequences of untimely or improper treatment of fractures of the talus neck often lead to complications, among which the main place is occupied by aseptic necrosis of its body and a violation of the biomechanics of walking and supporting function of the limb. Despite the fact that the use of stable internal and external fixation has led to a significant reduction in the percentage of complications, yet in the future the treatment of fractures of this localization remains a complex and unresolved issue. The aim of our investigation was to develop a device for transosseous osteosynthesis, which will restore the anatomy of the talus after a fracture of its neck and will improve the results of treatment of this category of patients. The results of treatment in 2 male patients aged 27 and 36 years with fractures of the talus neck were analyzed. Surgical management was based on the application of the method of controlled rod fixation in the external fixation apparatus developed in our clinic. The features and technique of using the original device in the treatment of patients with fractures of this localization are presented. The operations were performed within 2 to 4 days after the injury. Fixation of bone fragments in the apparatus lasted 10 weeks. After dismantling the device, a dosed load on the foot was prescribed with the help of the analyzer “Rehabilistep” developed in our clinic for 4 weeks. Early and long-term results of surgical treatment were traced in all patients in the period from 6 to 10 months after surgery. Radiological studies were performed on the 4th and 8th week after surgery and the Hawkins symptom was used to determine the presence or absence of talus block compaction. Evaluation of the results of recovery of anatomy and function of the foot showed that adequate and optimal surgical technique allowed to avoid complications, restore the function of the foot almost to the level of normal and get positive clinical results (92 points for AOFAS; 5.5 points for FFI). The device of our construction is compact and easy to use, so it can be the method of choice in the treatment of fractures of the neck of the talus and have a wide practical application in traumatological departments of different levels.