中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2014年
3期
298-305
,共8页
魏世隽%蔡贤华%黄继锋%徐峰%刘曦明%王庆%黄卫兵%王华松%兰生辉
魏世雋%蔡賢華%黃繼鋒%徐峰%劉晞明%王慶%黃衛兵%王華鬆%蘭生輝
위세준%채현화%황계봉%서봉%류희명%왕경%황위병%왕화송%란생휘
胫骨骨折%骨板%治疗结果
脛骨骨摺%骨闆%治療結果
경골골절%골판%치료결과
Tibial fractures%Bone plates%Treatment outcome
目的 探讨内外翻不同损伤机制导致胫骨Pilon骨折的特点、手术策略及疗效.方法 2008年6月至2012年8月收治胫骨Pilon骨折32例,内翻损伤17例、外翻损伤15例.内翻损伤组AO/OTA分型B型6例、C型11例,外翻损伤组均为C型.外翻损伤组中3例为GustiloⅡ型开放性骨折.根据主要骨折线及骨折块分布选择相应的手术入路行切开复位内固定,内翻损伤组主要支撑接骨板置于胫骨远端内侧,外翻损伤组置于胫骨远端前外侧;开放性骨折采用有限内固定结合外固定支架治疗.以Burwell-Charnley放射学评价标准判定关节面复位质量,记录美国矫形足踝协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足评分.结果 全部病例随访12~24个月,平均16.9个月.两组AO/OTA分型、合并腓骨骨折发生率的差异有统计学意义.内翻损伤组2例并发浅表感染;外翻损伤组4例并发浅表感染,2例深部感染,1例骨折延迟愈合,4例需转移皮瓣修复创面.内翻损伤组解剖复位9例、复位较好7例、复位一般1例,外翻损伤组解剖复位6例、复位较好8例、复位一般1例.术后12个月内翻损伤组AOFAS评分(87.06±2.70)分,外翻损伤组(82.80±3.47)分,差异无统计学意义.结论 内外翻不同损伤机制导致的胫骨Pilon骨折不同,应选择不同的手术方式.对内翻损伤应将主要支撑接骨板置于胫骨远端内侧、外翻损伤置于胫骨远端前外侧,可降低手术并发症发生率,近期临床疗效满意.
目的 探討內外翻不同損傷機製導緻脛骨Pilon骨摺的特點、手術策略及療效.方法 2008年6月至2012年8月收治脛骨Pilon骨摺32例,內翻損傷17例、外翻損傷15例.內翻損傷組AO/OTA分型B型6例、C型11例,外翻損傷組均為C型.外翻損傷組中3例為GustiloⅡ型開放性骨摺.根據主要骨摺線及骨摺塊分佈選擇相應的手術入路行切開複位內固定,內翻損傷組主要支撐接骨闆置于脛骨遠耑內側,外翻損傷組置于脛骨遠耑前外側;開放性骨摺採用有限內固定結閤外固定支架治療.以Burwell-Charnley放射學評價標準判定關節麵複位質量,記錄美國矯形足踝協會(American Orthopedic Foot and Ankle Society,AOFAS)踝與後足評分.結果 全部病例隨訪12~24箇月,平均16.9箇月.兩組AO/OTA分型、閤併腓骨骨摺髮生率的差異有統計學意義.內翻損傷組2例併髮淺錶感染;外翻損傷組4例併髮淺錶感染,2例深部感染,1例骨摺延遲愈閤,4例需轉移皮瓣脩複創麵.內翻損傷組解剖複位9例、複位較好7例、複位一般1例,外翻損傷組解剖複位6例、複位較好8例、複位一般1例.術後12箇月內翻損傷組AOFAS評分(87.06±2.70)分,外翻損傷組(82.80±3.47)分,差異無統計學意義.結論 內外翻不同損傷機製導緻的脛骨Pilon骨摺不同,應選擇不同的手術方式.對內翻損傷應將主要支撐接骨闆置于脛骨遠耑內側、外翻損傷置于脛骨遠耑前外側,可降低手術併髮癥髮生率,近期臨床療效滿意.
목적 탐토내외번불동손상궤제도치경골Pilon골절적특점、수술책략급료효.방법 2008년6월지2012년8월수치경골Pilon골절32례,내번손상17례、외번손상15례.내번손상조AO/OTA분형B형6례、C형11례,외번손상조균위C형.외번손상조중3례위GustiloⅡ형개방성골절.근거주요골절선급골절괴분포선택상응적수술입로행절개복위내고정,내번손상조주요지탱접골판치우경골원단내측,외번손상조치우경골원단전외측;개방성골절채용유한내고정결합외고정지가치료.이Burwell-Charnley방사학평개표준판정관절면복위질량,기록미국교형족과협회(American Orthopedic Foot and Ankle Society,AOFAS)과여후족평분.결과 전부병례수방12~24개월,평균16.9개월.량조AO/OTA분형、합병비골골절발생솔적차이유통계학의의.내번손상조2례병발천표감염;외번손상조4례병발천표감염,2례심부감염,1례골절연지유합,4례수전이피판수복창면.내번손상조해부복위9례、복위교호7례、복위일반1례,외번손상조해부복위6례、복위교호8례、복위일반1례.술후12개월내번손상조AOFAS평분(87.06±2.70)분,외번손상조(82.80±3.47)분,차이무통계학의의.결론 내외번불동손상궤제도치적경골Pilon골절불동,응선택불동적수술방식.대내번손상응장주요지탱접골판치우경골원단내측、외번손상치우경골원단전외측,가강저수술병발증발생솔,근기림상료효만의.
Objective To explore the surgical strategies of Pilon fractures caused by two different injury mechanisms.Methods From June 2008 to August 2012,32 patients with Pilon fractures were retrospectively analyzed in this study.These patients were divided into two groups (A-varus,B-valgus) according to the injury mechanisms.There were 17 patients in group A and 15 patients in group B.According to the AO/OTA classification,there were 6 type B,11 type C in group A and 15 type C in group B,with 3 cases of group B being Gustilo type Ⅱ open fractures.In group A,the buttress plate was placed on the medial aspect of distal tibia.However,the buttress plate was placed on the lateral aspect of distal tibia in group B.For those open fractures in group B,external fixation combined with limited internal fixation was performed.After the surgeries,the reduction quality of the joint surface was evaluated by Burwell-Charnley's radiological evaluation system.Clinical outcomes were evaluated by the AOFAS ankle-hindfoot scale.Results 32 cases were followed up for 12-24 months (average 16.9 months).There were statistic differences between group A and B according to both the AO/OTA classification and whether fibula fractures existed.In group A,2 cases developed wound infection.In group B,4 cases developed superficial wound infection,2 deep wound infection,1 delayed union of bone,and 4 needed flap transplantation to facilitate wound healing.The postoperative reductions were as follows:9 anatomic,7 good,and 1 fair in group A; 6 anatomic,8 good and 1 fair in group B.By 12 months postoperatively,there was no statistic difference between these two groups according to the AOFAS ankle-hindfoot scale,with the average scores of group A and B being 87.06±2.70 and 82.80±3.47 respectively.Conclusion Different injury mechanisms will result in different types of Pilon fractures.Different strategies should be used according to the characteristics of fracture to achieve better clinical outcomes and fewer complications,with the buttress plates being placed on the medial and lateral aspect of distal tibia in varus and valgus injury respectively.