CAJ | 학술논문

目的探讨闭合复位外固定架牵张固定治疗指骨Pilon骨折的临床疗效.方法自2008年10月至2012年12月采用外固定架闭合复位牵张固定治疗指骨Pilon骨折24例,男16例、女8例;年龄24～61岁,平均45.5岁.单纯Pilon骨折14例,其他合并掌、指骨骨折或肌腱损伤.所有Pilon骨折均为近指间关节闭合骨折,均采用闭合复位外固定架牵张固定治疗.结果术后随访6～24个月,平均8个月.术后4周拆除外固定支架1例,5周拆除10例,6周拆除13例,固定期间无支架松动,无针孔感染发生.去除外固定架后行功能锻炼.骨折临床愈合时间4～8周,平均6周.其中1例手指有20°旋转,5例关节间隙合并骨折块,影响功能的2例,后期行骨折块取出.按手指关节总活动度(TAM)标准评定手指功能:优5例,良16例,中2例,差1例;优良率87.5％.结论应用闭合复位外固定架牵张固定治疗指骨Pilon骨折简单、方便、实用、固定可靠,关节功能恢复好,近期疗效满意.
목적 탐토폐합복위외고정가견장고정치료지골Pilon골절적림상료효.방법 자2008년10월지2012년12월채용외고정가폐합복위견장고정치료지골Pilon골절24례,남16례、녀8례;년령24～61세,평균45.5세.단순Pilon골절14례,기타합병장、지골골절혹기건손상.소유Pilon골절균위근지간관절폐합골절,균채용폐합복위외고정가견장고정치료.결과 술후수방6～24개월,평균8개월.술후4주탁제외고정지가1례,5주탁제10례,6주탁제13례,고정기간무지가송동,무침공감염발생.거제외고정가후행공능단련.골절림상유합시간4～8주,평균6주.기중1례수지유20°선전,5례관절간극합병골절괴,영향공능적2례,후기행골절괴취출.안수지관절총활동도(TAM)표준평정수지공능:우5례,량16례,중2례,차1례;우량솔87.5％.결론 응용폐합복위외고정가견장고정치료지골Pilon골절간단、방편、실용、고정가고,관절공능회복호,근기료효만의.
Objective To explore the clinical outcomes of treating phalangeal Pilon fractures with closed reduction and external fixator stretch fixation.Methods From October 2008 to December 2012,twenty-four patients with Pilon fractures of the phalanx were treated with stretch fixation by an external fixator.There were 16 males and 8 females.Their ages ranged from 24 to 61 years,with an average of 45.5 years.Of the 24 cases,14 had only Pilon fractures.The rest had concomitant fractures of metacarpal or phalangeal shaft or partial/complete tendon ruptures.Pilon fractures were all closed,intra-articular fractures of the proximal interphalangeal joint.All the Pilon fractures were treated with closed reduction and external fixator stretch fixation.Results Postoperative follow-up ranged from 6 months to 2 years with an average of 8 months.The external fixator was removed at 4 weeks postoperatively in 1 patient,at 5 weeks in 10 patients,and at 6 weeks in 13 patients.There was neither loosening of the fixator nor pin track infection.Functional exercise resumed after external fixator removal.The time of fracture healing was 4 to 8 weeks,the average being 6 weeks.Rotational deformity of 20° was noted in one case.Residue fracture chips inside the joint cavity were seen in 5 cases.These intra-articular bone chips affected joint movement in 2 cases that warranted surgical removal of the bone chips.According to the functional evaluation criteria based on total active movement,the results were rated as excellent in 5 cases,good in 16 cases,fair in 2 cases,and poor in 1 case.The overall excellent and good rate was 87.5％.Conclusion Closed reduction and external fixator stretch fixation is a simple,convenient and practical method to treat Pilon fractures of the phalanx.It leads to reliable fixation,good joint function recovery and satisfactory short-term clinical outcomes.