多向锁定带锁髓内钉治疗胫骨pilon骨折的疗效分析  

Tibial pilon fractures treated by interlocking intramedullary nail with distal multi-directional locking

作　　者：熊庆广 王永清[1] 张庆杰[1] 毕红宾[1] 孙晋保 赵志辉[1] 杨志强[1] 李毅[1] 

机构地区：[1]天津医科大学第四中心临床学院骨科,300140

出　　处：《中华骨科杂志》2015年第7期720-726,共7页Chinese Journal of Orthopaedics

基　　金：天津市卫生局科技基金项目（09ky08）

摘　　要：目的 探讨多向锁定带锁髓内钉治疗胫骨pilon骨折的临床疗效.方法 回顾性分析2010年6月至2013年1月,采用多向锁定带锁髓内钉治疗并获得随访的23例胫骨pilon骨折患者资料,男15例,女8例;年龄32～ 61岁,平均36.9岁;左侧10例,右侧13例;均为新鲜骨折,其中闭合性骨折22例,开放性骨折1例（Tscherne分类1级）.pilon骨折采用AO/OTA分型：C1型10例,C2型8例,C3型5例.根据骨折线及骨折块分布情况选择入路行有限切开复位内固定,经撬拨复位后,使用非限制性锁钉将C型骨折变为A型骨折后使用髓内钉固定.术后以Burwell-Charnley放射学评价标准判定关节面复位质量,根据Teeny-Wiss踝关节临床症状和功能评分系统对术后功能进行评估.结果 23例患者均获得随访,随访时间18～ 24个月,平均（20.6±2.3）个月;骨折均愈合,愈合时间14～ 28周,平均（16.8±4.0）周.根据Burwell-Charnley放射学评价标准判定关节面复位质量,其中解剖复位20例,复位一般2例,复位差1例,解剖复位率为87.0％（20/23）;踝关节Teeny-Wiss评分为60～ 100分,平均（91.6±9.5）分;其中优12例,良8例,可2例,差1例,优良率为87.0％ （20/23）.7例出现张力性水疱;1例出现皮肤坏死.术后随访期间无一例出现感染、螺钉松动及断裂、畸形愈合、不愈合等并发症.结论 多向锁定带锁髓内钉治疗胫骨pilon骨折可获得良好复位和满意临床疗效,是一种安全可供选择的治疗方案.Objective To explore the clinical efficacy of pilon fracture treated by tibial multi-directional interlocking intramedullary nail.Methods From June 2010 to January 2013,data of 23 patients with pilon fracture who were treated by tibial multi-directional interlocking intramedullary nail were retrospectively analyzed.There were 15 males and 8 females,with an average age of 36.9 years （range,32-61 years）.They were all fresh fractures,including 22 cases of closed fractures and 1 case of opened fracture （Tscherne grade 1）.According to the AO/OTA classification,there were 10 fractures of type C1,8 fractures of type C2 and 5 fractures of type C3.According to the injury mechanisms,open reduction and internal fixation was used.Non-restrictive screws were used to convert type“C” to type “A” after pry poking reposition,then intramedullary nail was used to fixate the fracture.Burwell-Charnley radiological evaluation system was used for radiological assessment,and Teeny-Wiss ankle clinical symptoms and functional score system was used for efficacy assessment postoperative.Results The mean follow-up period was 20.6±2.3 months （range,18-24 months）.All fractures were healed at an average period of 16.8±4.0 weeks （range,14-28 weeks）.According to the Burwell-Charnley radiological evaluation system,20 cases had obtained anatomic reduction,2 cases fair reduction and only 1 case poor reduction.The anatomic reduction rate was 87.0% （20/23）.At the latest follow-up,the mean Teeny-Wiss score was 91.6±9.5 （range,60-100）.There were excellent in 12 cases,good in 8 cases,fair in 2 cases,and poor in 1 case,and the overall excellent and good rate was 87.0%（20/23）.None of the complications such as infection,breakage of screw loosening,malunion,nonunion occurred at the time of the latest follow-up,but 7 cases appeared tension blisters,one case appeared skin necrosis,and 6 cases got chronic pain in the knee postoperation.Conclusion Multi-directional interlocking intramedullary nail is a safe alternative for

关 键 词：胫骨骨折 骨折固定术 内 骨螺丝 

分 类 号：R687.3[医药卫生—骨科学]