截骨重建内固定治疗陈旧性后Pilon骨折  

Reconstructive osteotomy and internal fixation for old posterior Pilon fractures

作　　者：马富强[1] 王爱国[1] 王翔宇[1] 徐俊峰[1] MA Fu-qiang;WANG Ai-guo;WANG Xiang-yu;XU Jun-feng(Department of Foot and Ankle Surgery,Orthopedics Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州市骨科医院足踝外科,河南郑州450052

出　　处：《中国矫形外科杂志》2020年第24期2227-2230,共4页Orthopedic Journal of China

摘　　要：[目的]探讨截骨重建内固定治疗陈旧性后Pilon骨折的临床疗效。[方法] 2015年3月~2018年10月,收治陈旧性后Pilon骨折22例,其中男性15例,女性7例,年龄20~64岁,平均(38.42±9.25)岁;初次受伤至该次手术的时间为1~8个月,平均(4.93±2.94)个月。均给予切开沿原骨折线截骨重建内固定治疗。总结临床与影像资料。[结果] 22例患者均顺利手术,术中均未发生血管、神经损伤。所有患者均未发生伤口感染、皮肤坏死等其他并发症。所有患者随访16~53个月,平均(35.22±14.11)个月。除1例患者因疼痛持续加重,影像显示踝关节创伤性关节炎,于术后12个月退出随访,再次手术行踝关节融合,所有患者均获得良好恢复。末次随访时,患者踝关节跖屈、背伸活动度及AOFAS评分较术前显著增加(P<0.05),而VAS评分较术前显著降低(P<0.05)。影像方面,22例患者中,15例胫骨下端关节面解剖复位,胫距关节面完全匹配;6例胫骨下端关节面移位<2mm,胫距关节面基本匹配;1例移位≥2 mm,胫距关节面不匹配。截骨愈合时间3~6个月,平均(4.41±1.58)个月。[结论]通过切开复位截骨重建内固定治疗陈旧性后Pilon骨折可有效缓解患者症状,提高生活质量。[Objective] To investigate the clinical outcomes of reconstructive osteotomy and internal fixation for old posterior Pilon fractures. [Methods] From March 2015 to October 2018, a total of 22 patients, including 15 males and 7 females aged20-64 years with an average age of(38.42±9.25) years, underwent surgical treatment for old posterior Pilon fractures. After soft tissue released properly, perform reconstructive osteotomy on the previous fractured surface, then reduce articular surface to restore tibiotalar congruence and fixed osteotomy bone fragments with screws and plates. The clinical and radiographic documents were summarized. [Results] All patients had surgical procedures performed without iatrogenic injuries to nerves and blood vessels. No incision infection and necrosis happened in anyone of them. The follow-up period lasted for 16 to 53 months with an average of(35.22±14.11) months. Except one patients who quitted the follow-up and received revision arthrodesis for persistent pain and severe traumatic osteoarthritic change on images at 12 months postoperatively, all the patients got considerable recovery in symptoms and function. The VAS score for pain significantly decreased(P<0.05), whereas the range of motion(ROM) in plantar and dorsal flexion, as well as AOFAS score significantly increased at the latest follow-up compared with those before operation(P<0.05). With regard to radiographic assessment, the postoperative images revealed anatomic reduction with perfect tibiotalar congruence in 15 patients, articular displacement < 2 mm with good tibiotalar congruence in 6 patients, and articular displacement ≥ 2 mm with poor tibiotalar congruence in 1 patient. Bony healing of osteotomy achieved from 3 to 6 months with a mean of(4.41±1.58) months. [Conclusion] The reconstructive osteotomy and internal fixation for old posterior Pilon fracture do effectively relieve the symptoms of old posterior Pilon fractures and improve the quality of life of patients.

关 键 词：陈旧性后Pilon骨折 重建截骨 内固定 支撑钢板 

分 类 号：R683.42[医药卫生—骨科学]