扩大前外侧入路在外翻型pilon骨折合并腓骨骨折手术治疗中的应用效果  

Application of the extended anterolateral approach in valgus pilon fractures combined with fibula fractures

作　　者：杨康勇 赖志斌 朱永展[1] 沈国栋[1] YANG Kangyong;LAI Zhibin;ZHU Yongzhan;SHEN Guodong(Department of Foot and Ankle Surgery,Foshan Hospital of TCM,Foshan 528000,Guangdong,China)

机构地区：[1]佛山市中医院足踝外科,广东佛山528000

出　　处：《中华骨与关节外科杂志》2024年第10期904-908,共5页Chinese Journal of Bone and Joint Surgery

基　　金：佛山市卫生健康局医学科研课题(20220429)。

摘　　要：目的:探讨扩大前外侧入路在外翻型pilon骨折合并腓骨骨折手术治疗中的应用效果。方法:回顾性分析2016年9月至2023年6月佛山市中医院收治的37例外翻型pilon骨折合并腓骨骨折患者的临床资料。其中男24例,女13例,年龄21~55岁,平均(38.6±6.4)岁。国际内固定研究协会/美国骨创伤协会(AO/OTA)分型43C1型6例,43C2型11例,43C3型20例。均行扩大前外侧入路手术。随访观察骨折愈合情况,末次随访时记录疼痛视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)踝与后足评分。结果:37例患者均顺利完成手术。手术时间86~136 min,平均(108.2±12.1)min;术中出血量53~110 mL,平均(78.2±15.3)mL;住院时间12~22 d,平均(15.2±2.6)d。术后3 d复查踝关节正侧位X线片,骨折复位质量优14例(37.8%)、可22例(59.5%)、差1例(2.7%),骨折复位满意率为97.3%。术后第15日,患者手术切口甲级愈合34例(91.9%),乙级愈合3例(8.1%)。骨折愈合时间(13.8±1.1)周。所有患者均获得随访,随访时间13~22个月,平均(15.9±2.5)个月。至末次随访时,无一例患者出现内固定松动或断裂等情况。末次随访时,疼痛VAS评分为0~2分,中位数(四分位数)为1(0,1)分;AOFAS踝与后足评分为74~92分,平均(85.1±5.1)分,其中优12例(32.4%)、良23例(62.2%)。结论:外翻型pilon骨折合并腓骨骨折手术治疗中采用扩大前外侧入路可提供良好的术野范围,骨折固定牢靠,并发症发生率低,患者术后关节功能恢复良好。Objective:To evaluate the efficacy of the extended anterolateral approach in the surgical management of valgus pilon fractures combined with fibula fractures.Methods:A retrospective analysis was conducted on the clinical data of 37 patients with valgus pilon fractures combined with fibular fractures at Foshan Hospital of Traditional Chinese Medicine from September 2016 to June 2023,including 24 males and 13 females,with an average of 38.6±6.4(ranging 21-55)years.According to the AO/OTA classification,there were 6 cases with type 43C1,11 cases with type 43C2,and 20 cases with type 43C3.All patients underwent extended anterolateral approach surgery.Postoperative follow-up included assessment of fracture healing,and at the last follow-up,the Visual Analog Scale(VAS)for pain and the American Orthopaedic Foot&Ankle Society(AOFAS)Ankle-Hindfoot Scale scores were recorded.Results:All surgeries were successfully completed.The operation time ranged from 86 to 136 minutes,with an average of(108.2±12.1)minutes,the intraoperative blood loss ranged from 53 to 110 mL,with an average of(78.3±15.3)mL,and the hospital stay ranged from 12 to 22 days,with an average of(15.2±2.6)days.Anteroposterior and lateral X-ray images of the ankle joint at 3 days postoperatively showed excellent fracture reduction in 14 cases(37.8%),good reduction in 22 cases(59.5%),and fair reduction in 1 case(2.7%),resulting in an excellent and good rate of 97.3%.By the 15th postoperative day,34 patients(91.9%)had grade A incision healing,and 3 cases(8.1%)had grade B healing.The time to fracture healing was(13.8±1.1)weeks.Patients were followed up for 13-22 months,with an average of(15.9±2.5)months,and there was no loosening or breakage of internal fixation until the last follow-up.At the last follow-up,the VAS pain score was 0 to 2 points,with an average of(0.8±0.6)points,and the AOFAS Ankle-Hindfoot score was(85.1±5.1)points,with 12 cases(32.4%)rated excellent and 23 cases(62.2%)rated good.Conclusions:The extended anterolateral approach can provide

关 键 词：PILON骨折 外翻 腓骨骨折 前外侧 手术入路 

分 类 号：R683.4[医药卫生—骨科学]