切开复位截骨矫形治疗陈旧性pilon骨折  

Open reduction and osteotomy for old pilon fracture

作　　者：马富强[1] 王爱国[1] 王翔宇[1] 徐俊峰[1] 杨树东[1] 尚林[1] 张小龙 Ma Fuqiang;Wang Aiguo;Wang Xiangyu;Xu Junfeng;Yang Shudong;Shang Lin;Zhang Xiaolong(Department of Foot and Ankle Surgery, Zhengzhou Orthopaedics Hospital, Zhengzhou 450052, China)

机构地区：[1]郑州市骨科医院足踝外科,450052

出　　处：《中华创伤杂志》2019年第10期902-906,共5页Chinese Journal of Trauma

摘　　要：目的探讨切开复位截骨矫形辅助内固定重建胫骨远端关节面治疗陈旧性pilon骨折的疗效。方法采用回顾性病例系列研究分析2014年7月—2018年2月郑州市骨科医院收治的20例陈旧性pilon骨折患者临床资料,其中男14例,女6例;年龄21~45岁,平均31.5岁。初次受伤骨折根据AO分型:C1型4例,C2型7例,C3型9例,均为闭合性骨折。非手术治疗11例,手术治疗9例。骨折畸形愈合8例,骨折未完全愈合12例。其中胫骨远端后侧关节面塌陷8例,胫骨远端前侧关节面塌陷7例,内翻畸形3例,外翻畸形2例。均给予切开复位截骨矫形辅助内固定重建胫骨远端关节面治疗。记录骨折愈合时间,比较术前及末次随访视觉模拟评分(VAS)、踝关节屈伸活动度、美国足踝外科协会(AOFAS)踝-后足功能评分,观察并发症情况。结果患者均获随访7~36个月,平均26.4个月。骨折愈合时间为3~7个月,平均4.1个月。末次随访时VAS、踝关节跖屈和背伸、AOFAS踝-后足功能评分较术前均有显著改善[(1.9±1.0)分∶(6.6±1.4)分、(31.6±2.4)°∶(18.5±4.4)°、(25.7±2.7)°∶(15.6±2.7)°、(79.6±7.3)分∶(42.6±5.6)分](P<0.05)。其中AOFAS踝-后足功能评分优2例,良16例,可1例,差1例,优良率为90%。1例术后7个月出现严重踝关节创伤性关节炎,行二次踝关节融合术。结论对于陈旧性pilon骨折,切开复位截骨矫形辅助内固定重建胫骨远端关节面可有效缓解疼痛,改善关节活动度,恢复踝关节功能。Objective To investigate the efficacy of open reduction and osteotomy combined with internal fixation to reconstruct the distal tibial articular surface in the treatment of old pilon fracture. Methods A retrospective case series study was conducted to analyze the clinical data of 20 patients with old pilon fracture admitted to Zhengzhou Orthopaedic Hospital from July 2014 to February 2018. There were 14 males and six females, aged 21-45 years, with an average of 31.5 years. According to AO classification, there were four patients with C1 type, seven with C2 type and nine with C3 type, all of which were closed fractures. Eleven patients received non-operative treatment while nine patients underwent surgeries. After the surgery, malunion was seen in eight patients, and incomplete union in 12 patients. There were eight patients with posterior articular surface collapse of distal tibia, seven patients with anterior articular surface collapse of distal tibia, three patients with varus deformity and two patients with valgus deformity. All patients were treated with open reduction and osteotomy with internal fixation to reconstruct the articular surface of distal tibia. The time of fracture healing was recorded, and the Visual Analogue Scale (VAS), ankle flexion and extension range of motion, and AOFAS ankle-hind foot function score were compared before and at the last follow-up. The complications were recorded. Results All patients were followed up for 7-36 months, with an average of 26.4 months. Fracture healing time was 3-7 months, with an average of 4.1 months. At the last follow-up, VAS, ankle metatarsal flexion, dorsal extension and AOFAS scores were significantly improved compared with those before operation [(1.9±1.0)points vs.(6.6±1.4)points,(31.6±2.4)° vs.(18.5±4.4)°,(25.7±2.7)° vs.(15.6±2.7)°,(79.6±7.3)points vs.(42.6±5.6)points](P<0.05). One patient developed severe ankle traumatic arthritis 7 months after operation and underwent fusion of ankle joint. Conclusion For old pilon fracture, open redu

关 键 词：截骨术 足畸形 PILON骨折 

分 类 号：R687.3[医药卫生—骨科学]