CAJ | 학술논문

目的探讨重度开放性Pilon骨折的手术时机、手术方法选择及其对治疗效果的影响.方法 2003年4月至2008年7月收治开放性Pilon骨折患者21例,骨折按AO/OTA分类,均为C型,C2型17例,C3型4例;软组织损伤程度按照Gustilo标准,Ⅱ度18例,Ⅲ A度2例,Ⅲ B度1例.根据骨折类型、软组织损伤程度及受伤时间的不同采用两种不同的治疗方法,GustiloⅡ度C2型16例,GustiloⅡ度C3型2例,Gustilo ⅢA度C2型l例,采用创面清创胫骨有限内固定结合支架外固定术;GustiloⅢA度C3型1例,Gustilo ⅢB度C3型1例,采用创面清创跟骨牵引、延期手术.结果所有患者术后获得6～48个月的随访,平均24个月.骨折复位情况影像学评估结果(Burwell-Charnley标准):解剖复位6例,复位一般14例,复位差1例.骨折全部愈合,愈合时间2.5～11个月,平均4.7个月,其中骨折延迟愈合2例,延迟愈合率9.5%.创面皮肤浅表坏死2例,浅表感染2例,深部感染1例,感染率14.3%.早期出现踝关节创伤性关节炎8例,发生率38.1%.按美国骨科协会足踝外科分会(American Orthopedic Foot Ankle Society,AOFAS)评分标准:评分为66～94分,平均85.2分.主要并发症包括皮肤、软组织坏死、感染,骨折延迟愈合,创伤性关节炎等.结论治疗开放性Pilon骨折要根据骨折类型、软组织损伤程度及受伤时间的不同选择适当的手术时机和手术方式,正确评估软组织损伤情况、骨与软组织血运的保护是治疗关键.严格的清创、合理应用抗生素、酌情植骨、适时的功能锻炼可以减少并发症的发生.
목적 탐토중도개방성Pilon골절적수술시궤、수술방법선택급기대치료효과적영향.방법 2003년4월지2008년7월수치개방성Pilon골절환자21례,골절안AO/OTA분류,균위C형,C2형17례,C3형4례;연조직손상정도안조Gustilo표준,Ⅱ도18례,Ⅲ A도2례,Ⅲ B도1례.근거골절류형、연조직손상정도급수상시간적불동채용량충불동적치료방법,GustiloⅡ도C2형16례,GustiloⅡ도C3형2례,Gustilo ⅢA도C2형l례,채용창면청창경골유한내고정결합지가외고정술;GustiloⅢA도C3형1례,Gustilo ⅢB도C3형1례,채용창면청창근골견인、연기수술.결과 소유환자술후획득6～48개월적수방,평균24개월.골절복위정황영상학평고결과(Burwell-Charnley표준):해부복위6례,복위일반14례,복위차1례.골절전부유합,유합시간2.5～11개월,평균4.7개월,기중골절연지유합2례,연지유합솔9.5%.창면피부천표배사2례,천표감염2례,심부감염1례,감염솔14.3%.조기출현과관절창상성관절염8례,발생솔38.1%.안미국골과협회족과외과분회(American Orthopedic Foot Ankle Society,AOFAS)평분표준:평분위66～94분,평균85.2분.주요병발증포괄피부、연조직배사、감염,골절연지유합,창상성관절염등.결론 치료개방성Pilon골절요근거골절류형、연조직손상정도급수상시간적불동선택괄당적수술시궤화수술방식,정학평고연조직손상정황、골여연조직혈운적보호시치료관건.엄격적청창、합리응용항생소、작정식골、괄시적공능단련가이감소병발증적발생.
Objective To discuss the operative methods, timing and outcomes of severe open Pilon fractures. Methods From April 2003 to July 2008, 21 patients with open Pilon fractures were admitted. All the patients were type C fracture according to AO/OTA classification, including 17 cases of type C2 and 4 cases of type C3. According to Gustilo classification, there were 18 cases of type Ⅱ, 2 cases of type ⅢA, 1 case of type ⅢB. The patients were treated in two different ways: one-stage minimally invasive osteosynthesis for reconstruction of the articular surface with transarticular external fixation of the ankle (19 cases),which included 16 cases of Gustilo Ⅱ AO/OTA C2, 2 cases of type Gustilo Ⅱ AO/OTA C3 and 1 case of type Gustilo ⅢA AO/OTA C2. Formal open reconstruction of the articular surface by plating and external fixation was performed when the condition of soft tissue had improved (2 cases), which included 1 cases of type Gustilo ⅢA AO/OTA C3 and 1 cases of type Gustilo Ⅲ B AO/OTA C3. Results All the patients were followed up from 6 to 48 months, with the mean of 24 months. The outcome of reduction was evaluated by the Burwell-Charnley score. Anatomical reduction was found in 6 cases, function reduction was in 14 cases and poor reduction was 1 case. The heal-time ranged from 2.5 to 11 months, with the mean of 4.7 months. The delayed union occurred in 2 cases. The rate of delayed union was 9.5%. Two patients experienced skin superficial necrosis. There were superficial infection in 2 cases and deep infection in 1 case. The infection rate was 14.3%. Eight cases experienced early traumatic arthritis. The incidence of this complication was 38.1%.According to American Orthopedic Foot Ankle Society (AOFAS) scale for ankle joint, the result of the treatment was 66-94, with an average of 85.2. Conclusion It is important to have the optimal timing of surgery and reliable fixation according to fracture classification, the condition of soft tissue and time after injury. It is the key to evaluate the condition of soft tissue and protect the blood supply.