CAJ | 학술논문

目的探讨胫骨远端截骨、重建下肢力线治疗陈旧性pilon骨折畸形愈合的临床疗效.方法回顾性分析2010年1月至2012年5月采用胫骨远端截骨重建治疗的15例陈旧性pilon骨折畸形愈合患者资料,男12例,女3例;平均年龄30.8岁(24 ～39岁).术前负重位X线片及CT三维重建示:内翻畸形9例,外翻畸形2例,胫骨远端前方塌陷4例;4例患者存在胫距关节半脱位.所有患者术前均主诉踝关节疼痛、畸形及活动受限,并伴有行走困难.术后随访摄踝关节正、侧位X线片,并记录骨折愈合时间、疼痛视觉模拟评分(VAS)、SF-36健康调查简表评分、美国足踝外科协会(AOFAS)踝与后足评分、踝关节活动度及并发症情况等. 结果 13例患者术后获平均23.8个月(19 ～48个月)随访,2例失访.骨性愈合时间平均为3.8个月(3～7个月).末次随访时VAS评分由术前平均(5.1±3.2)分降低至(1.4±0.8)分,差异有统计学意义(P＜0.05),其中8例患者疼痛完全缓解.末次随访时AOFAS踝与后足评分、SF-36健康调查简表评分及踝关节活动度均较术前明显改善,差异均有统计学意义(P＜0.05).随访期间未见内固定失效、软组织并发症及进行性创伤性关节炎. 结论胫骨远端截骨的力线重建手术治疗陈旧性pilon骨折畸形愈合可有效恢复下肢力线,缓解疼痛症状,并改善踝关节功能,降低进行性创伤性关节炎发生率.
목적 탐토경골원단절골、중건하지력선치료진구성pilon골절기형유합적림상료효.방법 회고성분석2010년1월지2012년5월채용경골원단절골중건치료적15례진구성pilon골절기형유합환자자료,남12례,녀3례;평균년령30.8세(24 ～39세).술전부중위X선편급CT삼유중건시:내번기형9례,외번기형2례,경골원단전방탑함4례;4례환자존재경거관절반탈위.소유환자술전균주소과관절동통、기형급활동수한,병반유행주곤난.술후수방섭과관절정、측위X선편,병기록골절유합시간、동통시각모의평분(VAS)、SF-36건강조사간표평분、미국족과외과협회(AOFAS)과여후족평분、과관절활동도급병발증정황등. 결과 13례환자술후획평균23.8개월(19 ～48개월)수방,2례실방.골성유합시간평균위3.8개월(3～7개월).말차수방시VAS평분유술전평균(5.1±3.2)분강저지(1.4±0.8)분,차이유통계학의의(P＜0.05),기중8례환자동통완전완해.말차수방시AOFAS과여후족평분、SF-36건강조사간표평분급과관절활동도균교술전명현개선,차이균유통계학의의(P＜0.05).수방기간미견내고정실효、연조직병발증급진행성창상성관절염. 결론 경골원단절골적력선중건수술치료진구성pilon골절기형유합가유효회복하지력선,완해동통증상,병개선과관절공능,강저진행성창상성관절염발생솔.
Objective To evaluate the clinical outcomes of distal tibial osteotomy and alignment reconstruction for pilon fracture malunion.Methods Between January 2010 and May 2012, 15 cases of pilon fracture malunion were treated with super-malleolar extra-articular osteotomy and alignment reconstruction in our department.They were 12 males and 3 females,with an average age of 30.8 years (from 24 to 39 years).The pre-operative X-ray and CT scan showed varus deformity in 9 cases and valgus in 2.There were 4 cases of anterior impact of the distal tibia and 4 cases of tibiotalar subluxation.All the patients complained about ankle pain,deformity,limited range of motion (ROM) and walking difficulty.X-ray was taken routinely to confirm the bone healing during post-operative follow-up.Scores of visual analogue scale (VAS),American Orthopaedic Foot and Ankle Society (AOFAS) and The Short Form-36 (SF-36),ankle ROM and complications were also recorded.Results Of this cohort,13 cases obtained an average follow-up of 23.8 months (from 19 to 48 months) and 2 were lost to the follow-up.Bony union was achieved after an average of 3.8 months (from 3 to 7 months).The average VAS score declined significantly from 5.1 ± 3.2 preoperatively to 1.4 ± 0.8 postoperatively (P ＜ 0.05).A complete pain relief was achieved in 8 cases.The AOFAS ankle and hindfoot score,SF-36 score,ankle ROM at the last follow-up were improved significantly compared with the preoperative ones (P ＜ 0.05).No implant failure,soft tissue complications or post-traumatic arthritis occurred during the follow-up.Conclusion Distal tibial osteotomy and alignment reconstruction is an effective treatment of pilon fracture malunion,because this strategy can restore the lower limb alignment,relieve pain and decrease the rate of long-term post-traumatic arthritis.