摘要
目的探讨支撑钢板或结合空心螺钉治疗胫骨后pilon骨折的疗效。方法采用回顾性病例系列研究分析2010年2月-2015年2月收治的28例胫骨后pilon骨折患者临床资料，其中男18例，女lO例；年龄20-65岁，平均40．5岁。Klammer分型：1型10例，2型12例，3型6例。Denis—Weber分型：B型26例，C型2例。采用支撑钢板固定14例，从后向前空心螺钉固定4例，支撑钢板结合空心螺钉固定10例。术后观察患者的骨折复位情况、患肢功能及并发症发生情况，末次随访时记录踝关节活动范围。采用美国足踝外科协会（AOFAS）踝-后足功能评分标准、骨关节炎Kellgren-Lawrence分级和视觉模拟评分（VAS）进行临床疗效评估。结果所有患者切口均Ⅰ期愈合，除2例后关节面有1mm误差外，其余均获得解剖复位及稳定固定。术后随访时间13-36个月（平均20．6个月），骨折均Ⅰ期愈合，时间为6-10周（平均7．5周）。患者均无深部感染、下肢深静脉血栓形成。1例出现表皮坏死，给予加强换药后瘢痕愈合；1例出现腓骨肌腱激惹症状，取出内固定后消失；1例从后向前固定螺钉过长，出现皮肤刺激症状，取出螺钉后症状消失；1例单纯使用从后向前螺钉固定出现骨折块轻度移位，后期出现骨性关节炎；1例术后2个月出现屈躅畸形。末次随访时AOFAS踝-后足功能评分为（88．6±6．4）分，与术前的（32．2±1．3）分比较差异有统计学意义（P〈0．05）。Kellgren-Lawrence分级：0级24例，Ⅰ级2例，Ⅱ级1例，Ⅲ级1例。VAS术前为（8．5±1．5）分，术后为（6．3±1．0）分，末次随访为（0．8±0．3）分，与术前、术后比较差异有统计学意义（P〈0．05）。结论单独支撑钢板或结合空心螺钉固定治疗胫骨后pilon骨折，关节面可获得较好解剖复位，能有效减少术后并发症，临床效果良好。
Objective To study the effect of buttress plate fixation alone or combined with hollow screw fixation of posterior tibial pilon fractures. Methods A retrospective case series analysis was made on 28 cases of posterior tibial pilon fractures admitted from February 2010 to February 2015. There were 18 males and 10 females, aged from 20 to 65 years （mean, 40.5 years）. Klammer classification was type 1 in l0 cases, type 2 in 12 and type 3 in 6. Denis-Weber classification was type B in 26 cases and type C in 2 cases. Fourteen cases had buttress plate fixation, 4 hollow screw fixation through posterior-anterior approach, and 10 buttress plate fixation combined with hollow screws. Fracture reduction, function recovery, incidence of complications, and range of motion of ankle joint were detected after operation. American orthopedic foot and ankle society （AOFAS） ankle-hindfoot scale, Kellgren-Lawrence grading for osteoarthritis and visual analogue scale （VAS） were applied to evaluate clinical efficacy at the final follow-up. Results Operation incision healed by first intention. Anatomic reduction and rigid stabilization were noted in all, except that two cases presented one millimeter gap in the posterior articular surface. Duration of follow-up was 13 to 36 months （mean, 20. 6 months）. Time to fracture healing was 6 to 10 weeks after operation （mean, 7.5 weeks）. No deep incision infection or lower extremity deep venous thrombosis occurred after operation. One case developed epidermal necrosis, and resulted in scar healing by strengthening the dressing. One case developed fibula tendon irritation symptom, and disappeared after the removal of internal fixation. One case developed skin irritation symptom because of the overlong screw, and disappeared after the removal of the screw. One case developed osteoarthritis because of the mild displacement of fracture bone in the process of fixation. One case developed toe flexion deformity two months after operation. AOFAS scale was （88.6 ±6. 4） points at
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2017年第2期164-170,共7页
Chinese Journal of Trauma
基金
中国博士后科学基金面上项目（2016M591929）
江苏省“六大人才高峰”资助项目（2015-WSW-066）
关键词
胫骨骨折
踝
骨折固定术
内
Tibial fractures
Ankle
Fracture fixation, internal
