CAJ | 학술논문

目的：探讨后内侧切口治疗后 Pilon 骨折的临床疗效。方法回顾分析2010年7月至2013年7月，我院共手术治疗132例后踝骨折患者，根据入院时的影像学资料，其中27例诊断为后 Pilon 骨折，采用后内侧切口行切开复位内固定( open reduction and internal fixation，ORIF )治疗，且资料完整。男18例，女9例；年龄19～76岁，平均47.8岁；损伤机制包括坠落伤13例，平地扭伤7例，车祸伤7例；均伴外踝骨折及关节软骨面塌陷；所有患者足踝部肿胀、畸形及活动受限。患者均采用后内侧入路切开，骨折复位后螺钉或钢板固定。从外伤到手术时间1～14天，平均5.7天；术后定期随访切口及骨折愈合情况，并采用 AOFAS ( american orthopaedic foot and ankle society )踝与后足功能评分系统评价术后疗效。结果27例均获得随访，随访13～36个月，平均21.8个月。所有患者切口均一期愈合；术后2天 X 线片显示，解剖复位(胫骨远端关节面无台阶，踝穴正常)25例，复位良(胫骨远端关节面移位＜1 mm，踝穴增宽＜1 mm )2例，解剖复位率92.6%；27例骨折均愈合，愈合时间13～22周，平均16.3周。末次随访时 AOFAS 评分为76～100分，平均88.9分，其中优19例，良8例，优良率100%。结论后 Pilon 骨折采用后内切口可完全暴露整个后内侧骨折块，有利于骨折复位和固定，临床疗效满意，应作为治疗后 Pilon 骨折的首选入路。
목적：탐토후내측절구치료후 Pilon 골절적림상료효。방법회고분석2010년7월지2013년7월，아원공수술치료132례후과골절환자，근거입원시적영상학자료，기중27례진단위후 Pilon 골절，채용후내측절구행절개복위내고정( open reduction and internal fixation，ORIF )치료，차자료완정。남18례，녀9례；년령19～76세，평균47.8세；손상궤제포괄추락상13례，평지뉴상7례，차화상7례；균반외과골절급관절연골면탑함；소유환자족과부종창、기형급활동수한。환자균채용후내측입로절개，골절복위후라정혹강판고정。종외상도수술시간1～14천，평균5.7천；술후정기수방절구급골절유합정황，병채용 AOFAS ( american orthopaedic foot and ankle society )과여후족공능평분계통평개술후료효。결과27례균획득수방，수방13～36개월，평균21.8개월。소유환자절구균일기유합；술후2천 X 선편현시，해부복위(경골원단관절면무태계，과혈정상)25례，복위량(경골원단관절면이위＜1 mm，과혈증관＜1 mm )2례，해부복위솔92.6%；27례골절균유합，유합시간13～22주，평균16.3주。말차수방시 AOFAS 평분위76～100분，평균88.9분，기중우19례，량8례，우량솔100%。결론후 Pilon 골절채용후내절구가완전폭로정개후내측골절괴，유리우골절복위화고정，림상료효만의，응작위치료후 Pilon 골절적수선입로。
Objective To investigate the clinical outcomes of the posteromedial approach for posterior Pilon fractures.Methods The clinical data of 132 patients with posterior malleolar fractures who underwent surgical treatment from July 2010 to July 2013 were retrospectively analyzed. Based on the imaging data on admission, 27 patients with complete information were diagnosed with posterior Pilon fractures and were treated by open reduction and internal ifxation ( ORIF ) through a posteromedial approach. There were 18 males and 9 females, whose mean age was 47.8 years old ( range: 19-76 years ). The injury mechanisms included falling injuries in 13 patients, sprain on the lfat ground in 7 patients and motor vehicle accidents in 7 patients. Lateral malleolus fractures and articular cartilage surface subsidence were found in all the patients. Preoperatively, all the patients had foot and ankle swelling, deformity and restricted movement. The posteromedial approach was used in ORIF with screws or plates for all the fractures. The mean period from injury to surgery was 5.7 days ( range: 1-14 days ). Wound and fracture healing was recorded at regular intervals postoperatively. Functions were evaluated according to the American Orthopaedic Foot and Ankle Society ( AOFAS ) Ankle Hindfoot Scale.Results All the 27 patients were followed up for a mean period of 21.8 months ( range: 13-36 months ). All the incisions were primarily healed. The X-ray films at 2 days after the operation showed anatomical reduction in 25 patients with no articular stepoff in the distal tibia and normal width of the medial ankle mortise and good reduction in 2 patients with the articular stepoff in the distal tibia <1 mm and widening of the medial ankle mortise <1 mm. The rate of anatomical reduction was 92.6%. All the patients achieved fracture union, and the mean healing time was 16.3 weeks ( range: 13-22 weeks ). The mean AOFAS Ankle Hindfoot Scale score was 88.9 points ( range: 76-100 points ) in the latest follow-up. The clinical outcomes were excellent in 19 patients and good in 8 patients, and the excellent and good rate was 100%.Conclusions The whole posteromedial fracture fragment can be completely exposed in the treatment of posterior Pilon fractures using the posteromedial approach, and it becomes easy to perform fracture reduction and fixation. The clinical outcomes are satisfactory. Therefore, the posteromedial approach should be preferred for posterior Pilon fractures.