摘要
目的探讨严重pilon骨折的手术疗效。方法回顾性分析2010年3月至2016年9月广州市南沙区妇幼保健院骨外科组手术治疗并获随访的29例严重pilon骨折患者资料，男24例，女5例；年龄23～62岁，平均40．3岁；按AO／OTA分类：C1型9例，C2型12例，C3型8例。其中开放性骨折6例，闭合性骨折23例，合并腓骨骨折27例。22例患者行切开复位内固定，7例患者行有限内固定结合外固定。结果术后所有患者获平均15个月（12～25个月）的随访。骨折均获愈合，骨折愈合时间平均为16周（8～28周），其中骨折延迟愈合5例。踝关节功能根据美国足踝外科协会的踝-后足评分：优16例，良9例，可3例，差1例，优良率为86．2％。主要并发症包括皮肤创面浅表坏死3例，通过创面治疗后皮瓣修复治愈；浅表感染2例，深部感染2例，通过换药后治愈。结论严重pilon骨折需要根据不同的骨折类型、软组织损伤程度来选择选择合适的手术时间及治疗方式。
Objective To study operative treatment of severe tibia1 pilon fracture. Methods Between March 2010 and September 2016, 29 patients with severe pilon fracture received operative treatment and complete follow-up at Department of Orthopaedic Surgery, Maternal and Child Care Service Centre of Guangzhou Nansha District. They were 24 men and 5 women, aged from 23 to 62 years （average, 40. 3 years）. According to AO/OTA classification, 9 cases were type C1, 12 type C2 and 8 type C3. There were 6 open and 23 closed fractures. Of them, 27 were complicated with fibular fracture. Open reduction and intenal fixation was conducted in 22 cases and limited internal fixation combined with external fixation in 7. Results This cohort was followed up for an average of 15 months （from 12 to 25 mouths） . All the fractures obtained union after an average of 16 weeks （from 8 to 28 weeks）, but the union in 5 cases was delayed. According to American Orthopaedic Foot and Ankle Society （AOFAS） criteria for ankle and hind foot, 16 cases were rated as excellent, 9 as good, 3 as fair, one as poor, yielding an excellent to good rate of 86. 2%. The main complications included superficial necrosis of wound skin in 3 cases, which were cured by skin flap repair after wound treatment, and superficial and deep infection both in 2 cases, which were cured by dressing change. Conclusions Severe tibial pilon fractures should be treated according to their different types and severities of soft tissue injury, using different operative methods and timing.
作者
钟振锋
杜梅
曹任胜
Zhong Zhenfeng;Du Mei;Cao Rensheng(Department of Orthopaedic Surgery, Maternal and Child Care Service Centre of Guangzhou Nansha District, Guangzhou 511458, China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2018年第6期545-547,共3页
Chinese Journal of Orthopaedic Trauma
关键词
胫骨
踝关节
骨折
骨折固定术
内
Tibia
Ankle joint
Fractures
bone
Fracture fixation
internal
