基于CT断层扫描的手术入路策略在复杂胫骨Pilon骨折切开复位内固定中的应用  

Surgical approaches based on axial CT scan in open reduction and internal fixation for closed complex tibial Pilon fractures

作　　者：魏世隽[1] 蔡贤华[1] 徐峰[1] 兰生辉[1] 汤明[1] 齐凤宇[1] 

机构地区：[1]广州军区武汉总医院骨科,武汉430070

出　　处：《中国骨与关节外科》2016年第5期421-426,431,共7页Chinese Journal of Bone and Joint Surgery

摘　　要：背景：高能量损伤导致的复杂胫骨Pilon骨折常伴有较严重的软组织损伤，手术并发症发生率较高，而手术入路的合理选择直接关系到治疗的成败。目的：探讨基于CT断层扫描的手术入路策略在复杂胫骨Pilon骨折切开复位内固定中的应用及临床疗效。方法：回顾性分析2011年10月至2014年3月收治的29例复杂闭合性胫骨Pilon骨折，男21例，女8例，年龄24～65岁，平均（44．5±7．1）岁。依据AO／OTA分型，其中43C2型11例，43C3型18例，基于CT断层扫描的骨折线分布和骨块移位情况选择相应的手术入路，采用切开复位，组合接骨板内固定进行治疗。术后应用Burwell-Charn-ley放射学评价标准判定骨折复位质量，依据美国矫形足踝协会（AOFAS）踝与后足评分标准进行功能评价，记录相关并发症、骨折愈合时间及末次随访AOFAS评分。结果：27例获得随访，随访时间12～36个月，平均（21．4±6.3）个月，关节面获得解剖复位19例，复位较好5例，复位一般3例。骨折均于术后3-6个月愈合，平均愈合时间为（4．8±1．9）个月。末次随访未见骨折畸形愈合及内固定失败；末次随访时AOFAS评分67～95分，平均（85．4±6．5）分，其中优9例，良13例，可5例，差0例，优良率达81．5％。结论：在复杂胫骨Pilon骨折切开复位内固定术中应用基于CT断层扫描的的手术入路策略，可精准重建关节面，组合接骨板内固定牢靠，术后早期功能锻炼，有利于患肢功能恢复，相关并发症较少。Background： Complex Pilon fractures caused by high-energy injury usually accomplished with sever soft tissue injury, which may lead to high incidence of surgical complications. The rational choice of surgical approach is directly relat- ed to the clinical outcomes. Objective： To explore the application of the surgical approach based on axial CT scan in open re- duction and internal fixation for closed complex tibial Pilon fractures. Methods： Clinical of 29 patients with closed tibial Pi- Ion fractures treated in our hospital from October 2011 to March 2014 were retrospectively analyzed in this study. There were 21 males and 8 females with an average age of 44.5±7.1 years （range, 24-65 years）. According to the AO/OTA classifi- cation, 11 cases were classified into type 43C2 and 18 cases were type 43C3. Axial CT scanning was applied to evaluate the fracture lines and bone fragments, and then appropriate surgical approach was chosen for open reduction and internal fixa- tion. The reduction quality of the joint surface was evaluated by Burwell-Charnley＇s radiological evaluation system. The clinical outcomes were evaluated by the AOFAS ankle-hindfoot scale. Complications and bone healing time were recorded. Results： Eventually, 27 patients were followed up for 12-36 months （average 21.4±6.3 months）. Anatomic reduction was achieved in 19 patients, reduction was good in 5 patients and fair in 3. Bone union was achieved at an average 4.8~ 1.9 months （range, 3-6 months） postoperatively. No malunion or implant failure was found. At the last follow-up, the clinical outcome was excellent in 9 patients, good in 13, and fair in 5; the excellent and good rate was 81.5%. The average AOFAS ankle-hindfoot score was 85.4±6.5 （range, 67-95）. Conclusions： The surgical approaches based on CT scan in open reduc- tion and internal fixation can achieve wonderful reduction quality of the joint surface and better clinical outcomes with less complications in patients with closed complex tibial Pilon fractures.

关 键 词：胫骨骨折 内固定器 

分 类 号：R687.3[医药卫生—骨科学]