经关节内矫正截骨术治疗中青年陈旧性胫骨pilon骨折的疗效分析  

Corrective intra-articular osteotomy for malreduced tibial pilon fractures in young patients

作　　者：甘廷江 李亚星[1] 陈宇[1] 张晖[1] Gan Tingjiang;Li Yaxing;Chen Yu;Zhang Hui(Department of Orthopedics,Orthopedic Research Institute,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院骨科/骨科研究所,成都610041

出　　处：《中华创伤骨科杂志》2025年第1期25-31,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的观察经关节内矫正截骨术治疗中青年陈旧性胫骨pilon骨折的疗效。方法回顾性分析2013年1月至2022年12月四川大学华西医院骨科/骨科研究所采用经关节内矫正截骨术治疗的23例陈旧性胫骨pilon骨折患者资料。男21例,女2例;年龄42.9(28.6,48.1)岁。矫正截骨术距初次受伤或前次手术的间隔时间为97(51,166)d。采用美国足踝外科协会(AOFAS)踝-后足评分、健康调查简表(SF-36)、疼痛视觉模拟评分(VAS)、踝关节活动范围、改良Kellgren-Lawrence关节炎分期、并发症发生情况等评价疗效。结果所有患者术后随访35.4(26.2,72.2)个月。末次随访时所有患者的AOFAS踝-后足评分、SF-36、疼痛VAS评分和踝关节活动范围分别为(80.7±12.1)分、(72.2±13.9)分、2.0(0,3.0)分和23.0°(18.0°,30.0°)。末次随访时所有患者踝关节改良Kellgren-Lawrence分期:Ⅱ期17例,Ⅲ期5例,Ⅳ期1例。12例有充足术前评估资料的患者末次随访时的AOFAS踝-后足评分[(80.9±10.1)分]、SF-36[(72.9±12.0)分]、疼痛VAS评分[2.5(0.5,3.0)分]、踝关节活动范围(26.5°±7.9°)均较术前[(42.2±16.0)分、(36.0±8.8)分、6.0(5.5,6.5)分、21.3°±7.0°]显著改善,差异均有统计学意义(P<0.05)。1例患者疼痛明显,计划进行踝关节融合术。无患者出现深部感染、骨折不愈合或内固定失效等并发症。结论经关节内矫正截骨术治疗中青年陈旧性胫骨pilon骨折,可有效改善短期临床及影像结果,可能是一种治疗选择。ObjectiveTo evaluate corrective intra-articular osteotomy in the treatment of malreduced tibial pilon fractures in young patients.MethodsA retrospective study was conducted to analyze the 23 patients who had been treated for malreduced tibial pilon fractures by corrective intra-articular osteotomy from January 2013 to December 2022 at Department of Orthopedics,Orthopedic Research Institute,West China Hospital.They were 21 males and 2 females with a median age of 42.9(28.6,48.1)years.The median interval between intra-articular osteotomy and initial injury or previous surgery was 97(51,166)d.The clinical efficacy was assessed by the ankle-hindfoot score of American Orthopaedic Foot and Ankle Society(AOFAS),MOS item short form health survey(SF-36),visual analog scale(VAS)pain score,ankle range of motion(ROM),modified Kellgren-Lawrence arthritis grading,and complications.ResultsThe median follow-up period was 35.4(26.2,72.2)months.At the last follow-up,the AOFAS ankle-hindfoot score,SF-36,VAS pain score,and ankle ROM for all patients were,respectively,(80.7±12.1)points,(72.2±13.9)points,2.0(0,3.0)points and 23.0°(18.0°,30.0°),and the modified Kellgren-Lawrence arthritis grading revealed stageⅡin 17 cases,stageⅢin 5 cases,and stageⅣin 1 case.For the 12 patients with sufficient preoperative data,the AOFAS ankle-hindfoot score[(80.9±10.1)points],SF-36[(72.9±12.0)points],VAS pain score[2.5(0.5,3.0)points],and ankle ROM(26.5°±7.9°)at the last follow-up were significantly better than the preoperative values[(42.2±16.0)points,(36.0±8.8)points,6.0(5.5,6.5)points,and 21.3°±7.0°](all P<0.05).One patient who experienced significant pain postoperatively planned to receive ankle fusion surgery.No patients experienced deep infection,fracture non-union,or failure of internal fixation.ConclusionCorrective intra-articular osteotomy may be a viable alternative treatment of malreduced tibial pilon fractures in young patients,because it can effectively improve short-term clinical and radiographic outcomes.

关 键 词：胫骨 骨折 截骨术 PILON骨折 陈旧性骨折 

分 类 号：R687.3[医药卫生—骨科学]