Analysis To The Efficacy Of Two Different Surgical Approach Of The Talus Neck Fracture

Objective:Talus fractures in whole body bone fracture is relatively rare.Most of these are high-energy injuries,so there may be compound injury in patients.The talus are jointed to the leg and foot,ti is in the center of this position.Because of the special anatomical position,the treatment is difficult,combined with its poor blood supply,osteonecrosis are easily happened.So for a long time,the talus fractures has been considered to be the challenge of the traumatic orthopedic surgeon.For treatment of the talus fractures,there are a lot of literature,but most of these are scattered case type,operation comparison is relative singleness.These research did not put the operation to the level of the theory.In this paper,through summarizing the research experience of all kinds of literature and a retrospective case-control study.To compare different approach of the operation,the operation which contain bone cutting operation(i.e.the anteromedial approach with the medial malleolus osteotomy and anterolateral approach with the fibula osteotomy)and none osteotomy approach’s long-term efficacy of the talus neck fracture.Methods:We choose 41 patients from the cases in 4 hospitals in XX from 2005 to 2015.From these cases,we choose 20 patients who use the osteotomy approach(via medial malleolus osteotomy in 11 cases and the fibula osteotomy approach 9 cases)and 21 cases who has none osteotomy approach(anteromedial approach 12 cases,anterolateral approach 9 cases).Record the patient’s operation time spending,blood loss,hospitalization days,the condition of the wound healing,the condition of the bone healing and the postoperative function recovery(bythe American association of the ankle surgery after the ankle and foot scoring system),and to compare the curative effect of two kinds of surgical methods.Result:All the 41 cases receive tracking 1-2 years,average 1.6 years.Osteotomy group has a average age of 32.80±9.31.In this group,according to the Hawkins classfication,we have Ⅱtype 9 cases,Ⅲ type 9 cases,Ⅳ type 2 cases,the average operation time 96.5±10.89 is minutes,the average blood loss is 92.50±14.10 ml,the average hospitalization time is21.65±3.22 days.The none osteotomy group has a average age of 35.86±8.28.In 21 cases of this group,according to Hawkins classfication,9 cases had Ⅱ type,Ⅲ type 10 cases,Ⅳ type in 2 cases,the average operation time is 97.14±11.12 minutes,the average blood loss is88.57±16.14 ml,the average hospitalization days is 21.67±3.01 days.All postoperative patients were primary healing of incision,a total of 11 cases of postoperative ischemic necrosis,by AOFAS score,excellent 12 cases,good in 1 case,bad in1 case,excellent digital18,necrotic number is 2,fine rate was 90.00%;The group of none osteotomy group has excellent in 7 cases,good in 7 cases,bad in 2 cases,good number 12,necrotic number 9,fine rate was 57.14%.The two group in age,operation time,blood loss,hospitalization days and other operation data by two independent samples T test results(P > 0.05,no statistical significance,two groups of Hawkins fracture classification data by chi-square test results(P > 0.05,no statistical difference,therefore proves that the design follows the equilibrium experiments,the two group by AOFAS score number of necrosis and data obtained by the chi-square test results(P < 0.05,there is statistical significance,therefore,prove that osteotomy approach operation is better then the none osteotomy approach operation in the postoperative functional recovery and the prevention of ischemic necrosis of talus.