基于四柱理论分期治疗开放性pilon骨折的临床疗效  

Clinical outcomes of staged treatment for open pilon fracture based on four column theory

作　　者：王振 明晓锋 俞光荣 王社言 苏攀 刘青 杨波 冯彦江 李西要 WANG Zhen;MING Xiaofeng;YU Guangrong;WANG Sheyan;SU Pan;LIU Qing;YANG Bo;FENG Yanjiang;LI Xiyao(Department of Foot and Ankle Surgery,Zhengzhou Branch of Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provinvial Orthopedics Hospital),Zhengzhou 450000;Department of Foot and Ankle Surgery,Tongji Hospital of Tongji University,Shanghai 200068,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)郑州院区足踝外三科,郑州450000 [2]上海同济医院足踝外科,上海200068

出　　处：《中华骨与关节外科杂志》2023年第8期735-739,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：目的:探讨基于四柱理论分期治疗开放性pilon骨折的临床疗效。方法:回顾性分析2018年6月至2020年6月收治的20例胫骨开放性pilon骨折患者的临床资料。男18例,女2例;年龄37~48岁,平均(42.0±5.6)岁;左侧12例,右侧8例;距离第一次术后7~21 d,平均(14±7)d,通过二期个体化治疗。记录患者术前及术后1、6、12、24个月疼痛视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)踝-中足评分。随访观察临床结果和并发症情况。结果:20例患者获得随访18~24个月,平均(21.0±2.8)个月。所有患者骨折均1期愈合,骨折愈合时间为12~20周,平均(14±4)周。术后18例切口愈合;1例出现伤口反复渗出,经扩创抗生素骨粉置入控制感染;1例外固定架松动,给予加强固定。无血管神经损伤。末次随访时平均VAS评分为(2.5±0.5)分,AOFAS评分为(85±8)分。结论:开放性pilon骨折通过分期处理,以四柱理论为依据,加速康复外科(ERAS)理念贯穿整个治疗周期,通过制定个体化治疗方案,针对性处理每一柱的骨块和软组织覆盖间的关系,可大幅提高患者的临床功能,降低致残率。Objective:To investigate the clinical effect of staged treatment on open pilon fracture based on four-column theory.Methods:Clinical data of 20 patients with open pilon fracture of the tibia treated from June 2018 to June 2020 were retrospectively analyzed.There were 18 men and 2 women with a mean age of(42.0±5.6)years(range,37-48 years).The lefe was involved in 12 patients and the right was involved in 8 patients.The mean duration from the first operation to this admission was(14±7)d(range,7 to 21 d).Two-stage individualized treatment was conducted in all the patients.(visual analogue scale)VAS and American Orthopaedic Foot and Ankle Society(AOFAS)score system were used to evaluate curative effect before operation and 1,6,12 and 24 months after operation respectively.The clinical results and complications were observed.Results:Twenty patients were followed up for 18 to 24 months,with an average of(21.0±2.8)months.The fractures healed 12-20 weeks after operation,with an average healing time of(14±4)weeks.The incisions healed in 18 patients after operation.One patient had repeated exudation of the wound.The infection was controlled by the debridement and the placement of antibiotic bone powder.The fixators became loosened in another patient,which was fixed again.No vascular or neural injury occurred.At the last follow-up,VAS score was 2.5±0.5 and AOFAS score was 85±8.Conclusions:Based on the four-column theory,enhanced recovery after surgery(ERAS)concept,individualized treatment plan and targeted management of the relationship between bone blocks and soft tissue coverage of each column,the clinical function can be greatly improved,and the disability rate can be reduced in open pilon fracture patients with staged treatment.

关 键 词：胫骨骨折 四柱理论 临床疗效 

分 类 号：R683.4[医药卫生—骨科学]