改良前内侧入路治疗Ruedi-Allgower Ⅲ型Pilon骨折的疗效  

The Outcomes of Modified Anteromedial Approach in the Treatment of Ruedi-Allgower Ⅲ Pilon Fracture

作　　者：胡远军 成瑞萍 史会明[1] 王飞 任广铁 张志忠[1] Hu Yuanjun;Cheng Ruiping;Shi Huiming(WardⅠof Traumatic Orthopaedics Department,Hanzhong Central Hospital,Hanzhong 723000,China)

机构地区：[1]汉中市中心医院创伤骨科一病区

出　　处：《实用骨科杂志》2020年第2期124-127,共4页Journal of Practical Orthopaedics

基　　金：汉中市中心医院院级科研项目(YK1819)

摘　　要：目的探讨改良前内侧手术入路治疗Ruedi-AllgowerⅢ型Pilon骨折的临床疗效。方法回顾分析我科2015年1月至2018年1月38例闭合性Ruedi-AllgowerⅢ型Pilon骨折采用踝关节改良前内侧入路切开复位内固定治疗。其中男性30例,女性8例;年龄23~76岁,平均(48.0±11.7)岁。左侧19例,右侧19例。分析术中失血量、手术时间、美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)踝-后足功能评分及并发症情况。结果38例患者随访时间12~36个月,平均为(17.58±6.82)个月。37例切口甲级愈合,1例(2.6%)出现浅表切口皮缘坏死,术后无感染、无延迟愈合或骨折不愈合。术中失血量(99.87±53.28)mL,手术时间(134.39±26.11)min。术后采用Burwell-Charnley评价标准评价,优32例,良5例,差1例,优良率97.4%;末次随访踝关节AOFAS评分(93.66±3.76)分,其中优30例,良7例,可1例,优良率97.4%。结论踝关节改良前内侧入路是治疗Ruedi-AllgowerⅢ型Pilon骨折的一种有效的方法,对骨折周围软组织干扰小,疗效满意,值得临床进一步研究。Objective To explore the clinical outcomes of modified anteromedial approach in the treatment of Ruedi-AllgowerⅢPilon fractures.Methods 38 patients with closed Ruedi-AllgowerⅢPilon fracture were treated with open reduction and internal fixation through ankle modified anteromedial approach in our department retrospectively from January 2015 to January 2018.There were 30 males and 8 females with an average age of(48.0±11.7)(range:23 to 76),including 19 left and 19 right sides.The blood loss,operation time,American 0rthopedic Foot and Ankle Society(AOFAS)and the complications were analyzed.Results The average follow-up of 38 patients was(17.58±6.82)months(range:12 to 36 months).The incisions displayed grade A healing in 37 patients.One patient(2.6%)suffered from skin necrosis of superficial incision.There was no case of infection,delayed union or nonunion.The average bleeding were(99.87±53.28)mL and the average operation time were(134.39±26.11)min.According to evaluation criteria of Burwell-Charnley,there were 32 excellent cases,5 good and 1 poor and the excellent-good rate was 97.4%.At the last follow-up,the average AOFAS score of ankle were(93.66±3.76)points.30 cases were excellent,7 cases were good,and 97.4%of patients showed excellent-good results.Conclusion The Modified anteromedial approach of ankle is an effective method for the treatment of Ruedi-AllgowerⅢPilon fractures.It has little interference to the soft tissue and satisfactory effect.It is worthy of further clinical study.

关 键 词：PILON骨折 Ruedi-AllgowerⅢ型 改良前内侧入路 内固定 

分 类 号：R683.42[医药卫生—骨科学]