摘要
目的探讨切开复位内固定联合Ilizarov外固定支架踝关节牵张技术治疗距骨体粉碎性骨折的临床疗效。方法回顾性分析自2010年7月至2016年5月期间采用切开复位内固定联合Ilizarov外固定支架踝关节牵张技术治疗的16例距骨体粉碎性骨折患者资料。男9例，女7例；年龄17～56岁，平均35．6岁；通过术前、术后踝关节X线片及CT三维重建进行影像学结果评价；采用美国足踝外科协会（AOFAS）的踝-后足评分、疼痛视觉模拟评分（VAS）、健康简明量表（SF-36）以及患者满意度进行临床结果评价。结果14例患者术后获得13～52个月（平均33．3个月）随访。末次随访时8例患者发生创伤性关节炎，4例患者出现距骨缺血性坏死。AOFAS的踝．后足评分为30～97分，平均69．8分；VAS评分为0～6分，平均2．5分；SF-36中躯体健康评分为18～55分，平均41．7分；精神健康评分为40～70分，平均54．1分。患者满意度评价：非常满意2例，满意5例，一般满意4例，不满意3例。结论采用切开复位内固定联合Ilizarov外固定支架踝关节牵张技术治疗距骨体粉碎性骨折，可以获得较好的临床结果。
Objective To evaluate open reduction and internal fixation （ORIF） combined with Ilizarov joint distraction in the treatment of comminuted talar body fractures. Methods Between July 2010 and May 2016, 16 patients with comminuted talar body fracture underwent ORIF followed by ankle joint distraction by Ilizarov external fixator at our department. They were 9 males and 7 females, aged from 17 to 56 years （average, 35.6 years）. Radiological assessments were conducted by plain radiographs and computed tomography （CT） scans pre- and post-operatively. Clinical outcomes were evaluated according to visual analogue scale （VAS）, American Orthopedic Foot and Ankle Society （AOFAS） hindfoot score, the short form （SF） -36 health survey scores and patients＇ satisfaction. Results Two patients were lost to follow-up. The remaining 14 patients were followed up for an average duration of 33.3 months （from 13 to 52 months）. All the fractures united. Superficial wound infection occurred in one case. Eight patients developed post-traumatic osteoarthris; 4 patients presented with avascular necrosis. At final follow-ups, the AOFAS scores ranged from 30 to 97 points （mean, 69.8 points）, the VAS scores from 0 to 6 points （mean, 2.5 points）, the physical component summary in SF-36 from 18.0 to 55 points （mean, 41.7 points）, and the mental component summary from 40 to 70 points （mean, 54.1 points） . Two patients reported strong satisfaction, 5 satisfaction, 4 moderate satisfaction, and 3 dissatisfaction. Conclusion For eomminuted talar body fractures, ORIF combined with Ilizarov joint distraction is a new and effective treatment which can not only provide adequate fixation strength but also reduce the incidence of post-traumatic osteoarthris or avascular necrosis.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2017年第12期1024-1028,共5页
Chinese Journal of Orthopaedic Trauma
关键词
距骨
骨折
粉碎性
骨生成
牵张
切开复位内固定
ILIZAROV
Talar
Fractures, comminuted
Osteogenesis, distraction
Open redaction and internal fixation
Ilizarov
