采用前内侧扩大入路治疗复杂闭合性pilon骨折的疗效分析  

Efficacy Analysis of Anteromedial Extensile Approach in the Treatment of Complicated Closed Pilon Fractures

作　　者：陈子贤[1] 姜南春[1] 曹渊武[1] 吴晓[2] 施德源[1] 

机构地区：[1]复旦大学附属中山医院骨科,上海200032 [2]复旦大学附属中山医院青浦分院,上海201700

出　　处：《中国临床医学》2015年第2期176-180,共5页Chinese Journal of Clinical Medicine

摘　　要：目的:评价采用前内侧扩大入路治疗AO/OTA分型C2、C3型复杂闭合性pilon骨折的疗效。方法:采用前内侧扩大入路对23例(25处)胫骨远端复杂闭合性pilon骨折的患者进行切开复位内固定治疗。23例中男性18例,女性5例;平均年龄为(43.7±9.0)岁;术前AO分型为C2型11处,C3型14处。记录手术时间、术中出血量、骨折愈合时间、并发症发生情况、美国足踝外科协会(AOFAS)评分等,分析该入路的安全性、适应症及优缺点。结果:平均手术时间为(119.6±23.6)min,术中出血量为(168±64.4)mL,骨折愈合时间为(12.5±5.4)周。术后12个月及24个月的AOFAS评分分别为(81.9±18.2)分、(79.9±19.5)分。有4例患者出现并发症,无内固定物失效患者。结论:手术治疗复杂pilon骨折时,采用前内侧扩大入路能够充分显露胫骨远端内外侧柱和关节面,软组织并发症发生率低,临床效果较为满意。Objective：To evaluate the efficacy of anteromedial extensile approach in the treatment of complicated closed pilon fractures classified as type AO/OTA C2 or C3 . Methods：Twenty‐three patients ,who suffered from complicated closed pilon fractures of distal tibia（25 lesions） ,underwent open reduction and internal fixation with anteromedial extensile approach . Among the 23 patients , there were 18 males and 5 females , with mean age of （43 .7 ± 9 .0 ） years . According to AO classification ,there were 11 lesions of type C2 and 14 lesions of type C3 .Operating time ,blood loss ,time of fracture healing , situation of complications ,and American Orthopedic Foot＆amp;Ankle Society（AOFAS） score were recorded ,so as to analyze the safety ,the indication ,and the pros and cons of this approach . Results：The average operating time was （119 .6 ± 23 .6）min . The intraoperative blood loss was （168 ± 64 .4） mL .And the time of fracture healing was （12 .5 ± 5 .4）weeks .The AOFAS scores were 81 .9 ± 18 .2 and 79 .9 ± 19 .5 at 12 month and 24 month after surgery ,respectively .Four cases of complications were observed , and there was no patient with invalid internal fixation . Conclusion：During the surgical treatment of complicated closed pilon fractures ,the anteromedial extensile approach allows complete access to the medial and lateral column of distal tibia and the articular surface ,so that the incidence rate of soft tissue complications was low and the clinical efficacy was satisfactory .

关 键 词：PILON骨折 前内侧扩大入路 内固定治疗 

分 类 号：R683.42[医药卫生—骨科学]