摘要
目的评估后内侧切口治疗后Pilon骨折的临床疗效。方法回顾分析2008年4月-2013年4月我院139例后踝骨折患者临床资料,根据入院时的影像学资料,其中29例诊断为后Pilon骨折,并采用后内侧切口行切开复位内固定治疗且资料完整。男性19例,女性10例;年龄21-74岁,平均46.3岁。损伤原因包括坠落伤12例,平地扭伤10例,道路交通伤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。受伤至手术时间1-11d,平均5.3d;术后定期随访切口及骨折愈合情况,并采用美国足踝外科学会（AOFAS）踝与后足功能评分系统评价术后疗效。结果 29例均获随访,随访时间15-47个月,平均24.6个月。所有患者切口均一期愈合;术后2d X线片显示,解剖复位（胫骨远端关节面无台阶,踝穴正常）26例,复位良好（胫骨远端关节面移位〈1mm,踝穴增宽〈1mm）3例,解剖复位率89.7%;29例骨折均愈合,愈合时间12-21周,平均15.2周。末次随访时AOFAS评分为81-100分,平均89.5分,其中优21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。
Objective To evaluate the clinical outcome of open reduction and internal fixation through posteromedial approach for the treatment of posterior Pilon fracture. Methods Data of 139 patients with posterior malleolar fractures from Apr. 2008 to Apr. 2013 in our hospital were retrospectively analyzed. Among them,29 patients whose X ray and CT scan showed posterior Pilon fracture were involved in this study. There were 19 males and 10 females with the mean age of 46. 3 years（ ranged from 21 to 74 years）. The mechanism of injury included falling in12 patients,strain in 10 patients,and motor vehicle accidents in 7 patients. All patients were accompanied with lateral malleolus fracture and articular cartilage collapse. All patients had foot and ankle swelling,deformity and restricted movement. Open reduction and internal fixation through posteromedial approach was applied. The period from injury to surgery was 1 to 11 days,with an average of 5. 3 days. The condition of wound and fracture healing was regularly recorded after operation. Function was evaluated according to the AOFAS Ankle Hindfoot Scale. Results All 29 patients were followed up for 15 to 47 months（ mean,24. 6 months）. The incisions in all patients received primary healing. Postoperative X ray showed anatomical reduction in 26 patients with no articular collapse and normal ankle mortise and 1 mm of collapse and 1mm widening of the medial ankle mortise in 3 patients. The rate of anatomical reduction was 89. 7%（ 26 /29）. All patients achieved fracture union and the healing time ranged from 12 to 21 weeks（ mean,15. 2 weeks）. The AOFAS Ankle Hindfoot Scale were 81 to 100 points（ mean,89. 5points）. There were excellent outcomes in 21 patients and good in 8 patients,and the excellent and good rate was100%. Conclusion Treatment of posterior Pilon fracture through posteromedial approach can achieve a good surgical field and easy anatomical reduction with satisfactory clinical outcome. Therefore,the posteromedial approach should be the preferred
出处
《创伤外科杂志》
2015年第2期141-144,共4页
Journal of Traumatic Surgery
关键词
踝关节
骨折
内固定
手术
ankle joint
fracture
internal fixation
surgery
