CAJ | 학술논문

目的探讨踝关节面有限切开复位结合微创接骨术(minimally invasive plate osteosynthesis,MIPO)置入锁定加压接骨板(locking compression plate,LCP)内固定治疗胫骨Pilon骨折的方法及临床疗效. 方法选择2009年8月-2011年8月收治的21例胫骨Pilon骨折患者,其中男16例,女5例；年龄21 ～68岁,平均42.3岁.骨折根据AO/OTA分型:43B型12例,43C型9例；开放性骨折2例(均为Gustilo-AndersonⅠ型).采用有限切开复位踝关节面,结合MIPO技术置入LCP内固定的方法进行治疗,术后非负重早期功能锻炼. 结果 21例手术患者中19例术后获得12 ～24个月随访,平均14个月.应用Burwell-Chamley影像学评价标准判定骨折复位质量,关节面获得解剖复位17例,复位一般2例,以上患者骨折均获得骨性愈合.根据Mazur等制定的踝关节评分系统进行术后功能评价:优7例,良10例,可2例,差0例,优良率达89％. 结论有限切开复位结合LCP内固定治疗Pilon骨折能有效重建关节解剖关系,减少软组织剥离,固定牢靠,配合早期功能锻炼,有利于患肢功能恢复.
목적 탐토과관절면유한절개복위결합미창접골술(minimally invasive plate osteosynthesis,MIPO)치입쇄정가압접골판(locking compression plate,LCP)내고정치료경골Pilon골절적방법급림상료효. 방법 선택2009년8월-2011년8월수치적21례경골Pilon골절환자,기중남16례,녀5례；년령21 ～68세,평균42.3세.골절근거AO/OTA분형:43B형12례,43C형9례；개방성골절2례(균위Gustilo-AndersonⅠ형).채용유한절개복위과관절면,결합MIPO기술치입LCP내고정적방법진행치료,술후비부중조기공능단련. 결과 21례수술환자중19례술후획득12 ～24개월수방,평균14개월.응용Burwell-Chamley영상학평개표준판정골절복위질량,관절면획득해부복위17례,복위일반2례,이상환자골절균획득골성유합.근거Mazur등제정적과관절평분계통진행술후공능평개:우7례,량10례,가2례,차0례,우량솔체89％. 결론 유한절개복위결합LCP내고정치료Pilon골절능유효중건관절해부관계,감소연조직박리,고정뢰고,배합조기공능단련,유리우환지공능회복.
Objective To investigate methods and clinical effects of limited open reduction of ankle articular surface and locking compression plate (LCP) placement using minimally invasive plate osteosynthesis (MIPO) in managing tibial Pilon fractures.Methods Twenty-one patients with tibial Pilon fractures treated between August 2009 and August 2011 were involved in the study,including 16 males and 5 females,at age of 21-68 years (average 42.3 years).According to AO/OTA classification,12 patients were with type 43B fractures and nine with type 43C fractures.There were two patients with open fractures (both Gustilo-Anderson type Ⅰ fractures).Limited open reduction of ankle articular surface plus LCP placement using MIPO were performed.Early functional training without weight-bearing was carried out postoperatively.Results Nineteen patients were followed up for 12-24 months (average 14 months).According to Burwell-Chamley' s radiological evaluation system,17 patients obtained anatomical reduction of articular surface and two patients obtained moderate reduction,but they all had bony healing.Ankle function evaluated by Mazur' s criterion were excellent in seven patients,good in 10 and fair in two,with excellence rate of 89％.Conclusion Limited open reduction combined with LCP internal fixation can successfully construct articular anatomic relationship,decrease soft tissue dissection and attain solid fixation in treatment of Pilon fractures and further facilitate functional recovery of the affected extremity in coordination with early functional exercise.