摘要
目的:观察采用直接入路治疗Pilon骨折的临床疗效。方法:采用延期直接入路内固定治疗45例Pilon骨折。其中开放性骨折5例,闭合性骨折40例,合并腓骨骨折31例;AO分型:B2型6例,B3型4例,C1型13例,C2型16例,C3型6例。软组织损伤恢复后进行切开复位直接入路内固定。患者术前进行X线和CT平扫加三维重建检查,根据骨折方式和软组织损伤情况制定直接入路手术方案。术后采用Baird-Jackson评分系统进行临床评估。结果:本组45例患者平均随访时间(14.2±2.2)月,骨折愈合时间平均(13.7±2.1)周。平均AOFAS评分(86.5±6.3)分;平均VAS评分(1.4±0.3)分。4例发生浅表感染,局部换药后治愈;2例开放性骨折出现深部感染,去除内固定改为外固定支架固定后治愈;3例患者出现轻度的畸形愈合;4例延迟愈合;9例患者X线有不同程度的关节退变,其中2例因关节炎程度较重伴有长期疼痛进行了关节融合,其余患者X线虽有关节炎表现但踝关节功能良好。根据Baird-Jackson评分系统本组优良率86.67%(39/45)。结论:直接入路治疗Pilon骨折的临床疗效令人满意。
Objective to explore the clinical outcomes of treatment of Pilon fractures through specific direct approaches. Methods 45 patients with Pilon fractures were treated with open reduction and internal fixation through specific direct approaches with recovery of the soft tissue after 9.6 days （ range ： 7 to 13 days）. There were 33 males and 12 females with a mean age of 34. 5 years （ range ： 19 to 61 years）. Among all 45 cases, 40 were close fractures, 5 were open fractures and 31 were combined with fibular fractures. According to the classification of AO/OTA, 6 patients had type B2 fractures, 4 had type B3 fractures, 13 had type C1 fractures, 16 had type C2 fractures and 6 had type C3 fractures. Before the operation, all patients were examined with plain radiography and 3D CT. A detailed surgical plan was made through specific approaches before the definitive operation, in which, a well designed approach was included in consideration of the specific fracture patterns. Radiographic and clinical examinations were used for postoperative follow - up. The Baird - Jackson scale score system was used to evaluate the functional outcomes. Results All 45 patients were followed up. The mean follow - up time was （14.2 ±2.2） months （range： 9 to 44 months）. All fractures healed at an average of （13.7 ±2. 1） weeks （range： 10 to 25 weeks）. The mean AOFAS score was （86. 5±6. 3） points （range： 71 to 97 points）, and the mean VAS score was （ 1.4 ± 0. 3 ） points （ range ： 0 to 6 points ）. Superficial wound infection occurred in 4 patients, which healed with local treatments. Deep tissue infection was found in 2 patients with open fracture. In the 2 cases, the implanted metalwork was removed and external fix- ation was used until the wound and fracture healed. Malunion occurred in 3 patients and delayed union occurred in 4 patients. Post - traumatic arthritis was found in 9 patients with the radiographic examination, two of whom underwent arthrodesis because of the long - term pain
出处
《中国民族民间医药》
2015年第13期28-29,31,共3页
Chinese Journal of Ethnomedicine and Ethnopharmacy
关键词
PILON骨折
骨折方式
直接入路
内固定
Pilon fracture
fracture pattern
direct approach
internal fixation
