踝关节后内侧入路治疗距骨后突内侧结节骨折1例报道及文献复习

张永涛　祝海炳　马一平　戴海东　吕和　叶群

[关键词] 距骨骨折;踝关节;手术入路;骨折内固定

[中图分类号] R683          [文献标识码] B          [文章編号] 1673-9701（2021）17-0143-04

Fracture of the posterior medial tubercle of the talus treated with posteromedial ankle approach： a case report and literature review

ZHANG Yongtao   ZHU Haibing   MA Yiping   DAI Haidong   LV He   YE Qun

Department of Orthopedics-Foot and Ankle Surgery， Zhoushan Hospital of Traditional Chinese Medicine， Zhoushan 316000， China

[Abstract] Fracture of the posterior medial tubercle of the talus is rare in clinical practice and is easy to be missed and misdiagnosed. Fracture of the posterior medial tubercle of the talus， also known as Cedell fracture， has a deep anatomical position， and it is relatively difficult to expose and fix it in clinical operation. There is still a lack of standardized diagnosis and treatment methods for fractures. Treatment of fracture of the posterior medial tubercle of the talus treated with posteromedial ankle approach can fully expose the posterior medial tubercle of the talus， which is beneficial to fracture fixation and joint function recovery. This article retrospectively analyzes a case of fracture of the posterior medial tubercle of the talus treated with posteromedial ankle approach， reviews and summarizes the relevant literature to evaluate the clinical effect and improve clinicians′ understanding， and develops the best treatment plan for patients with fracture of the posterior medial tubercle of the talus.

[Key words] Talus fracture; Ankle joint; Surgical approach; Fracture internal fixation

距骨后突内侧结节骨折临床少见，容易漏诊、误诊[1，2];单纯距骨后突内侧结节骨折更是罕见[3]，在诊断上普通X线（X-ray，X线）检查临床容易漏诊，常需电子计算机断层扫描（computed tomography，CT）辅助检查精确诊断。由于临床研究报道相对较少，对其治疗及手术入路临床常存在困惑及争议。距骨后内侧结节位置较深，骨折显露、复位、固定困难，常规内侧入路，内踝截骨损伤较大且显露不够清楚，内固定植入相对困难，传统螺钉钉尾容易激惹周围组织引起不适，如治疗不当可出现骨折不愈合、距下关节不稳、骨折碎片进入距下关节并发关节炎，从而影响患者功能。2015年5月至2019年5月，我们采用经踝后内侧入路切开复位采用直径3.0 mm双头加压螺钉固定治疗8例涉及距骨后突内侧结节骨折病例，临床效果满意，现回顾分析本院1例典型病例并复习相关文献，以提高临床医生对该病的认识及治疗。

1 资料与方法

1.1 一般资料

患者男性，35岁，于2018年12月2日工作中扭伤右足肿胀畸形约1 h来我院就诊。患者1 h前在工作楼梯踩空扭伤，伤后当即右足疼痛，不能在站立行走。由120急诊送至本院就诊，急诊科给予右踝关节正侧位拍片检查，提示右距下关节脱位（图1）、第5跖骨基部骨折（图2）;给予手法复位、石膏固定，并办理住院进一步检查治疗。入院后专科查体：右踝肿胀明显，内踝下皮肤淤青，无皮肤破损，内踝下压痛明显，足部感觉正常，足背及胫后动脉搏动良好，足趾血运良好，右足趾被动背伸时内踝疼痛明显;治疗上给予患足石膏固定，止痛、患肢抬高消肿，冰袋冷敷24 h等。……