改良双切口治疗合并腓骨骨折的Pilon骨折疗效观察  

IMPROVED DOUBLE OPERATIVE APPROACHES FOR TREATMENT OF Pilon FRACTURES ACCOMPANIED WITH FIBULA FRACTURES

作　　者：王明鑫[1] 刘德昌[1] 王坤[1] 孟德强[1] 丁悦[1] 

机构地区：[1]复旦大学附属金山医院骨科,上海201508

出　　处：《中国修复重建外科杂志》2016年第12期1483-1487,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨改良前正中入路联合后外侧入路治疗合并腓骨骨折的Pilon骨折疗效。方法2012年1月-2015年6月，采用改良前正中入路联合后外侧入路行切开复位内固定术治疗合并腓骨骨折的Rfiedi—AUgowerIU型Pilon骨折19例。男13例，女6例；年龄23～68岁，平均35岁。致伤原因：交通事故伤11例，高处坠落伤7例，重物压砸伤1例。根据AO／OTA分型，c2型4例，c3型15例。根据软组织损伤Tscherne—Gotzen分级，1级6例，2级13例。受伤至手术时间6～18d，平均10．3d。术后采用Burwell—Charnley影像学评价标准评价Pilon骨折复位情况，采用美国矫形足踝协会（AOFAS）踝-后足评分系统评价踝关节功能。结果手术时间1．8．4．6h，平均2．4h；术中出血量200～500mL，平均310mL。19例均获随访，随访时间12～18个月，平均13.7个月。骨折愈合时间2．5～8．0个月，平均3．6个月。术后前正中切口边缘部分坏死2例，并发创伤性关节炎2例，踝关节不稳定1例。术后12个月，根据BurweU—Charnley影像学评价标准，解剖复位15例，复位一般4例。根据AOFAS评分，优11例，良5例，可3例，优良率为84．2％。结论改良前正中入路联合后外侧入路操作简便、显露充分、创伤较小，是治疗合并腓骨骨折的Pilon骨折的一种安全有效方法。Objective To investigate the clinical effect of surgical treatment of Pilon fractures accompanied with fibula fractures with the improved double operative approaches. Methods Between January 2012 and June 2015, 19 patients with dosed Pilon fractures accompanied with fibula fractures （Rtiedi-Allg6wer type III） underwent open reduction and internal fixation with improved anterior-median incision and posterior-lateral incision. There were 13 males and 6 females, aged 35 years on average （range, 23-68 years）. Injury was caused by traffic accident in 11 cases, falling from height in 7 cases, and crash injury of heavy object in 1 case. According to AO/OTA classification, there were 4 cases of type C2, and 15 cases of type C3. According to Tscherne-Gotzen classification of soft tissue defect, 6 cases were rated as grade 1 and 13 cases as grade 2. The interval of injury and operation was 6-18 days （mean, 10.3 days）. After operation, reduction of Pilon fracture was evaluated by the Burwell-Charnley radiological evaluation criteria, and the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society （AOFAS） ankle-hindfoot score. Results The operation time was 1.8-4.6 hours （mean, 2.4 hours）; the intraoperative blood loss was 200-500 mL （mean, 310 mL）. All the 19 patients were followed up for 13.7 months on average （range, 12-18 months）. The fracture healing time was 3.6 months on average （range, 2.5-8.0 months）. Postoperative complications included anterior-median incision necrosis in 2 cases, traumatic arthritis in 2 cases, and ankle instability in I case. According to Burwell-Charnley radiological evaluation criteria, anatomical reduction was obtained in 15 cases and satisfactory reduction in 4 cases. According to AOFAS score, the excellent and good rate was 84.2% （excellent in 11 cases, good in 5 cases, and fair in 3 cases）. Conclusion The improved anterior-median incision combined with posterior-lateral incision is a safe and effective method to treat comple

关 键 词：PILON骨折 腓骨骨折 内固定 改良双切口 

分 类 号：R687.3[医药卫生—骨科学]