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Abstract：
OBJECTIVE: To investigate the clinical effect of the anteromedial cannulated screw approach in the treatment of Hawkins II/III talus fractures in children.
METHODS: A retrospective study was conducted on 20 children with talar fractures admitted to Renmin Hospital from September 2018 to February 2022. The fracture healing and functional recovery of the affected limb were strictly followed up after the operation. There were 14 males and 6 females. The average age was 9 years (range 6-12 years). According to the Hawkins classification, there were 12 cases of talar neck fracture type II and 8 cases of type III. All patients were fixed with cannulated compression screws via an anteromedial approach. According to the American Orthopedic Foot and Ankle Society ankle and hindfoot function scoring system, limb function was evaluated before and after the operation. A visual analog scale was used to evaluate the degree of postoperative pain.
RESULTS: All 20 children were followed up for 12 months to 30 months, with an average of 15 months. We found that there was no significant difference in the excellent and good rate (76.9%) and necrosis rate (30.8%) between male children and female children (71.4%) and necrosis rate (28.6%) (P > 0.05). The excellent and good rates (92.9%) of children younger than 9 years old at the time of injury were higher than those of children older than 9 years old (33.3%), and the incidence of avascular necrosis of the talus was lower. The differences between the two groups were statistically significant (P < 0.05). The average prognosis score of children who underwent surgery within 5 days after injury was 89.2 ± 6.4, which was significantly higher than that of children who underwent surgery after 5 days (72.9 ± 13.1), and the difference was statistically significant (P < 0.05). There was no significant difference between patients who underwent surgery within 5 days after injury (15.4%) and those who underwent surgery after 5 days (51.7%) (P > 0.05). The excellent and good rates of talar neck fracture type II and talar neck fracture type III were 90.1% and 55.6%, respectively.
CONCLUSIONS: The anteromedial approach combined with cannulated compression screws for the treatment of Hawkins II/III talus fractures in children not only has a clear surgical field, but the fracture can also be reduced and fixed under direct vision using this technique. It does not affect the stability of the ankle joint and is conducive to the recovery of ankle function. It can be used as a surgical scheme for the treatment of talar fractures in children.
METHODS: A retrospective study was conducted on 20 children with talar fractures admitted to Renmin Hospital from September 2018 to February 2022. The fracture healing and functional recovery of the affected limb were strictly followed up after the operation. There were 14 males and 6 females. The average age was 9 years (range 6-12 years). According to the Hawkins classification, there were 12 cases of talar neck fracture type II and 8 cases of type III. All patients were fixed with cannulated compression screws via an anteromedial approach. According to the American Orthopedic Foot and Ankle Society ankle and hindfoot function scoring system, limb function was evaluated before and after the operation. A visual analog scale was used to evaluate the degree of postoperative pain.
RESULTS: All 20 children were followed up for 12 months to 30 months, with an average of 15 months. We found that there was no significant difference in the excellent and good rate (76.9%) and necrosis rate (30.8%) between male children and female children (71.4%) and necrosis rate (28.6%) (P > 0.05). The excellent and good rates (92.9%) of children younger than 9 years old at the time of injury were higher than those of children older than 9 years old (33.3%), and the incidence of avascular necrosis of the talus was lower. The differences between the two groups were statistically significant (P < 0.05). The average prognosis score of children who underwent surgery within 5 days after injury was 89.2 ± 6.4, which was significantly higher than that of children who underwent surgery after 5 days (72.9 ± 13.1), and the difference was statistically significant (P < 0.05). There was no significant difference between patients who underwent surgery within 5 days after injury (15.4%) and those who underwent surgery after 5 days (51.7%) (P > 0.05). The excellent and good rates of talar neck fracture type II and talar neck fracture type III were 90.1% and 55.6%, respectively.
CONCLUSIONS: The anteromedial approach combined with cannulated compression screws for the treatment of Hawkins II/III talus fractures in children not only has a clear surgical field, but the fracture can also be reduced and fixed under direct vision using this technique. It does not affect the stability of the ankle joint and is conducive to the recovery of ankle function. It can be used as a surgical scheme for the treatment of talar fractures in children.
摘要：
目的：探讨前内侧空心钉入路治疗儿童HawkinsII/III距骨骨折的临床疗效。
方法：对人民医院2018年9月至2022年2月收治的20例距骨骨折患儿进行回顾性研究。术后严格随访患肢骨折愈合及功能恢复情况。有14名男性和6名女性。平均年龄为9岁（6-12岁）。根据霍金斯的分类,距骨颈Ⅱ型骨折12例,Ⅲ型骨折8例。所有患者均通过前内侧入路用空心加压螺钉固定。根据美国骨科足踝协会踝足和后足功能评分系统，在手术前后评估肢体功能。使用视觉模拟量表评估术后疼痛程度。
结果：20例患儿均获随访，随访时间为12个月至30个月，平均15个月。我们发现，男女儿童的优良率（76.9％）和坏死率（30.8％）与坏死率（28.6％）之间没有显着差异（P>0.05）。9岁以下儿童受伤时优良率(92.9%)高于9岁以上儿童(33.3%),距骨缺血性坏死的发生率较低。两组比较差异有统计学意义(P<0.05)。伤后5天内接受手术治疗的患儿平均预后评分为89.2±6.4,明显高于伤后5天接受手术治疗的患儿(72.9±13.1),差异有统计学意义(P<0.05)。伤后5天内接受手术的患者(15.4%)与伤后5天接受手术的患者(51.7%)差异无统计学意义(P>0.05)。距骨颈骨折Ⅱ型和距骨颈骨折Ⅲ型的优良率分别为90.1%和55.6%,分别。
结论：前内侧入路联合空心加压螺钉治疗儿童HawkinsII/III距骨骨折不仅手术视野清晰，但是使用这种技术，骨折也可以在直视下缩小和固定。不影响踝关节的稳定性，有利于踝关节功能的恢复。可作为治疗儿童距骨骨折的手术方案。
方法：对人民医院2018年9月至2022年2月收治的20例距骨骨折患儿进行回顾性研究。术后严格随访患肢骨折愈合及功能恢复情况。有14名男性和6名女性。平均年龄为9岁（6-12岁）。根据霍金斯的分类,距骨颈Ⅱ型骨折12例,Ⅲ型骨折8例。所有患者均通过前内侧入路用空心加压螺钉固定。根据美国骨科足踝协会踝足和后足功能评分系统，在手术前后评估肢体功能。使用视觉模拟量表评估术后疼痛程度。
结果：20例患儿均获随访，随访时间为12个月至30个月，平均15个月。我们发现，男女儿童的优良率（76.9％）和坏死率（30.8％）与坏死率（28.6％）之间没有显着差异（P>0.05）。9岁以下儿童受伤时优良率(92.9%)高于9岁以上儿童(33.3%),距骨缺血性坏死的发生率较低。两组比较差异有统计学意义(P<0.05)。伤后5天内接受手术治疗的患儿平均预后评分为89.2±6.4,明显高于伤后5天接受手术治疗的患儿(72.9±13.1),差异有统计学意义(P<0.05)。伤后5天内接受手术的患者(15.4%)与伤后5天接受手术的患者(51.7%)差异无统计学意义(P>0.05)。距骨颈骨折Ⅱ型和距骨颈骨折Ⅲ型的优良率分别为90.1%和55.6%,分别。
结论：前内侧入路联合空心加压螺钉治疗儿童HawkinsII/III距骨骨折不仅手术视野清晰，但是使用这种技术，骨折也可以在直视下缩小和固定。不影响踝关节的稳定性，有利于踝关节功能的恢复。可作为治疗儿童距骨骨折的手术方案。
