摘要
目的探讨后pilon骨折内、外侧双切口入路的治疗效果。方法2013年1月-2017年9月成都市第一人民医院骨科共收治26例后pilon骨折患者,其中女10例,男16例;年龄20~62岁,平均41岁;12例高坠伤,4例交通伤,6例下楼梯摔伤,4例下陡坡摔伤。Tscherne-Gotzen分度:Ⅰ度9例,Ⅱ度17例。按照CT扫描的AGH分类:Ⅰ型6例,Ⅱ型14例,Ⅲ型6例。受伤至手术时间7~10d,平均8.4d。手术在俯卧位下选择内外侧双切口入路,中和钢板固定外踝骨折,T型支撑钢板固定后踝骨折,空心螺钉固定后内侧及内踝骨折。治疗后通过临床检查及影像学随访,Burwell-Charnley放射学评价标准判断骨折对位、对线情况,AOFAS踝-后足评分评估疗效,VAS疼痛评分评估疼痛程度。结果26例治疗后随访平均11.5(10~13)个月,未见钢板螺钉失效、感染等情况发生。末次随访Burwell-Charnley放射学评价:26例中优18例,可8例,踝关节结构正常、稳定,对位对线正常,功能恢复良好;AOFAS踝-后足评分平均93(85~98)分,优22例,良4例;平均VAS评分1.2(0~3)分,优20例,良6例。结论采用内外侧双切口入路直视下协调复位治疗胫骨后pilon骨折,固定牢固、可靠,不易出现相关并发症,可获得满意的临床效果。
Objective To investigate the therapeutic effect of a two-incision approach using medial and lateral incisions for posterior pilon fracture.Methods From January 2013 to September 2017,26 cases with posterior pilon fractures were treated in Chengdu First People's Hospital,including 10 females and 16 males,aged 20-62 years with an average of 41 years.Twelve cases injured by falling from high,4 cases by traffic accident,6 cases by falling down stairs and 4 cases by roll downhill.According to Tscherne- Gotzen grading,9 cases were in grade Ⅰ and 17 cases in grade Ⅱ.According to AGH classification of CT scan,6 cases were in grade Ⅰ,14 cases in grade Ⅱ and 6 cases in grade Ⅲ.The time from injury to operation ranged from 7 d to 10 d,with an average of 8.4 d.Surgery was performed in prone position by medial and lateral incisions approach.Lateral malleolar fracture was fixed with neutral plate,posterior malleolar fracture with T supported plate,and posteromedial and medial malleolus fracture with hollow screw.Patients were followed up,Burwell-Charnley scale was used to judge the alignment of fracture,AOFAS ankle-hind foot scale was used to evaluate the curative effect,and VAS was used to assess the pain level at the site of injury.Results All patients were followed up for 10 to 13 months (average 11.5 months).No plate screw failure or infection occurred.At the end of follow-up, Burwell-Charnley imaging evaluation showed that the ankle joints structure and alignment restored to normal,and their function recovered well;18 cases achieved excellent and 8 cases achieved fair outcome.The average AOFAS ankle-hind foot score was 93 (range,85 to 98) with 22 cases having excellent and 4 cases having good results.The average VAS score was 1.2 points (range,0 to 3),with 20 cases having excellent and 6 cases having good results.Conclusion The open reduction by medial and lateral incisions approach can be used under direct vision for posterior pilon fracture.The fixation is effective and reliable with satisfactory clinical resu
作者
姚晓克
李建华
顾祖超
黄文刚
何朝华
罗干
钟茜梅
张伟
刘建恒
张峻
YAO Xiaoke;LI Jianhua;GU Zuchao;HUANG Wengang;HE Chaohua;LUO Gan;ZHONG Qianmei;ZHANG Wei;LIU Jianheng;ZHANG Jun(Department of Orthopedics,Chengdu First People's Hospital,Chengdu 610041,Sichuan Province,China;Department of Orthopedics,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Orthopedics,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010010,Inner Mongolia Automous Region,China)
出处
《解放军医学院学报》
CAS
2019年第4期328-332,共5页
Academic Journal of Chinese PLA Medical School
关键词
后pilon骨折
踝关节
手术复位
posterior pilon fractures
ankle joint
operative reduction
