分期手术治疗复杂闭合Pilon骨折  

Staged operation for complex closed Pilon fracture

作　　者：姜刚强[1] 焦福德 应霁翀[1] 虞天明 刘建磊[1] 庄云强[1] JIANG Gang-qiang;JIAO Fu-de;YING Wen-chong;YU Tian-ming;LIU Jian-lei;ZHUANG Yun-qiang(Department of Traumatic Orthopaedics,Ningbo No.6 Hospital,Ningbo 315040,Zhejiang,China)

机构地区：[1]宁波市第六医院创伤骨科,浙江宁波315040

出　　处：《中国骨伤》2022年第9期878-882,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨分期手术治疗复杂闭合Pilon骨折的临床疗效。方法:自2019年6月至2021年6月,采用分期手术治疗29例复杂闭合Pilon骨折的患者,其中男18例,女11例;年龄31~68(43.50±6.62)岁;骨折按照Ruedi-Allgower分型,Ⅱ型7例,Ⅲ型22例。29例患者均为新鲜闭合骨折,且不合并距骨骨折、跟骨骨折等损伤。记录患者从受伤至闭合复位外固定时间、2次分期手术间隔时间、骨折愈合时间及并发症情况,并采用美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足功能评分评价临床疗效,采用Burwell-Charnley系统进行放射学复位评价。结果:29例患者均获得随访,时间13~30(15.43±5.31)个月。术后所有骨折获得骨性愈合,愈合时间2~6(3.77±1.22)个月,未发现内固定断裂、螺钉松动、感染、内固定激惹、踝关节僵硬等并发症。受伤至闭合复位跨踝关节固定时间1.22~7.34 h,2次分期手术间隔5~9(5.98±2.11)d。术后12个月患侧踝关节AOFAS评分(90.10±10.11)分,与术前的(34.11±6.89)分比较差异有统计学意义(P<0.05)。按照AOFAS踝关节评分,优16例,良9例,可4例。术后12个月采用Burwell-Charnley骨折复位放射学评价标准,15例解剖复位,12例良好复位,2例复位差。结论:采用分期手术治疗复杂闭合Pilon骨折,具有并发症少、骨折复位满意、骨折固定牢固等优点,能够获得良好的踝关节功能恢复。Objective:To explore clinical efficacy of staged surgery in treating complex closed Pilon fracture. Methods:From June 2019 to January 2021,29 patients with complex closed Pilon fracture were treated by staging surgery,including 18 males and 11 females,aged ranged from 31 to 68 years old with an average of(43.50±6.62) years old;7 cases were type Ⅱ and 22 cases were type Ⅲ according to Ruedi-Allgower classification. All patients had fresh closed fractures without talus and calcaneal fractures. The time from injury to closed reduction and external fixation,the interval between two stages of surgery,fracture healing time and complications were recorded. American Orthopedic Foot and Ankle Society(AOFAS) was used to assess clinical effects. Burwell-Charnley system was used to evaluate radiological reduction. Results:All 29 patients were followed up from 13 to 30 months with an aver age of(15.43±5.31) months. All fractures healed well from 2 to 6 months with an average of(3.77 ±1.22) months. No internal fixation fracture,screw loosening,infection,internal fixation irritation,ankle stiffness occurred. The time from injury to closed reduction and cross-ankle fixation ranged from 1.22 to 7.34 h with an average of(2.31±3.52) h,the interval between two stages ranged from 5 to 9 days with an average of(5.98±2.11) days. AOFAS score was improved from 34.11±6.89 before operation to 90.10±10.11 after oepration at 12 months(P<0.05). According to AOFAS grading,16 patients got excellent result,9 good and 4 moderate. Fifteen patients got anatomic reduction,12 patients were good reduction,and 2 cases were poor reduction according to Burwell-Charnley system. Conclusion:Staged surgery for complex closed Pilon fracture has advantages of less complications,statisfied reduction,stable fixation,which could obtain good recovery of ankle joint.

关 键 词：闭合性Pilon骨折 外固定架 切开复位 内固定 

分 类 号：R683.42[医药卫生—骨科学]