分期手术治疗合并腓骨骨折的开放性Pilon骨折的疗效分析  

Therapeutic effect of staging treatment of open Pilon fracture with fibula fracture

作　　者：曹明宇[1] 续斌[1] 王雪[1] 李飞[1] 王成伟[1] CAO Mingyu;XU Bin;WANG Xue;LI Fei;WANG Chengwei(Department of Orthopaedics,Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第六附属医院骨科

出　　处：《足踝外科电子杂志》2019年第2期37-41,共5页Electronic Journal of Foot and Ankle Surgery

基　　金：国家自然科学基金(8186030127);新疆维吾尔自治区自然科学基金(2017D01C267)

摘　　要：目的研究分期切开复位内固定手术治疗合并腓骨的开放性Pilon骨折的临床疗效。方法回顾性分析2014年10月~2018年1月因外伤入院的新鲜开放性Pilon骨折患者17例的临床资料。所有患者均采用分期治疗,Ⅰ期急诊行腓骨骨折切开复位内固定,胫骨闭合复位外固定架固定,术后消肿对症治疗。Ⅱ期手术于皮纹征出现后行Pilon骨折切开或有限切开钉板系统内固定。术后观察创面情况,并依据X线片及CT评价骨折愈合时间和对位情况,随访时按照美国足踝外科协会((American Orthopaedic Foot&Ankle Society,AOFAS))踝关节与后足功能评分及视觉模拟评分法(VAS)对踝关节功能评估。结果所有患者的Ⅰ期手术在伤后4~10.5 h内进行,平均(6.8±1.6)h。Ⅱ期手术时间为Ⅰ期术后7~16 d,平均11 d。所有患者腓骨侧骨折采用切开复位钉板系统固定;胫骨侧骨折Ⅰ期采用单臂外固定架固定,Ⅱ期行骨折端有限切开复位,并更换为钉板系统行内固定。所有患者均未出现感染。17例患者均获得最终随访,随访时间12~46个月,平均(24.5±5.6)个月。骨折均于术后12~24周愈合,平均(14.8±2.1)周。AOFAS评分为72~86分,平均(81.6±1.9)分。VAS评分在休息时、活动时及负重行走时分别为(0.31±0.03)分、(0.92±0.04)分和(1.78±0.09)分。截至随访期末,所有患者未出现创伤性关节炎。结论分期手术治疗开放性Pilon骨折疗效满意,值得临床运用。Objective To investigate the curative effect of staged surgery in the treatment of opening pilon fracture with fibula fracture.Methods Clinical data of 17 cases fresh open Pilon fracture admitted to hospital from October 2014 to January 2018 were retrospectively analyzed.All patients were treated by staged surgery.First-stage emergency treatment included open reduction and internal fixation of fibular fracture,closed reduction and external fixation of tibia,and symptomatic treatment of postoperative swelling.Pilon fracture was incised or fixed with limited screw-plate system after dermatoglyphic sign appeared in the second stage of operation.The wound healing time and alignment were evaluated by X-ray and CT.The ankle function was evaluated by AOFAS ankle and hind foot function score and visual analogue score(VAS)during follow-up.Results All patients underwent one-stage surgery within 4-10.5 hours after injury,with an average of(6.8+1.6)hours.The second stage operation lasted from 7 to 16 days after the first stage operation,with an average of 11 days.All patients with fibular side fracture were fixed with open reduction and nail-plate system;tibial side fracture was fixed with one-arm external fixator at the first stage and limited open reduction at the second stage,and replaced with nailplate system for internal fixation.No infection occurred in all patients.All the 17 patients were followed up for 12 to 46 months,with an average of(24.5+5.6)months.Fractures healed 12 to 24 weeks after operation,with an average of(14.8+2.1)weeks.AOFAS score ranged from 72 to 86,with an average of(81.6+1.9).The VAS scores were(0.31+0.03),(0.92+0.04)and(1.78+0.09)at rest,activity and weight-bearing walking,respectively.At the end of the follow-up period,no traumatic arthritis was found in all patients.Conclusion The curative effect of staged surgery is satisfactory and it is worthy of clinical application.

关 键 词：分期手术 开放性PILON骨折 疗效分析 

分 类 号：R687.3[医药卫生—骨科学]