摘要
目的探讨后内侧胫后肌腱前方入路联合后外侧入路切开复位内固定治疗KlammerⅡ/Ⅲ型后pilon样骨折的临床疗效。方法采用回顾性病例系列研究分析2015年1月至2019年12月江苏省人民医院及江苏省人民医院溧阳分院收治的37例后pilon样骨折患者临床资料,其中男17例,女20例;年龄25~65岁[(49.5±9.3)岁]。KlammerⅡ型20例,KlammerⅢ型17例。均采用后内侧胫后肌腱前方入路联合后外侧入路切开复位内固定治疗。观察术后骨折复位、切口愈合及并发症情况。观察随访过程中是否有骨折复位丢失或内固定失效等情况发生。记录骨折愈合时间。末次随访时采用视觉模拟评分(VAS)及美国足踝外科协会(AOFAS)踝-后足评分评估疼痛及踝关节功能。结果患者均获随访12~20个月[(15.6±1.2)个月]。骨折均解剖复位;切口均Ⅰ期愈合;无切口感染、皮肤坏死、胫后血管神经束损伤、下肢深静脉血栓、足趾马缰绳样畸形等并发症。随访过程中无骨折复位丢失或内固定失效。骨折愈合时间为11~16周[(13.2±1.4)周]。VAS由术前的6~9分[(8.0±0.8)分]改善至末次随访的0~2分[(1.2±0.6)分](P<0.01)。末次随访时AOFAS踝-后足评分为80~100分[(89.7±4.6)分],其中优15例,良22例,优良率100%。结论后内侧胫后肌腱前方入路联合后外侧入路切开复位内固定治疗KlammerⅡ/Ⅲ型后pilon样骨折复位满意,术后并发症少,疼痛明显缓解,功能恢复良好。
Objective To investigate the clinical efficacy of posteromedial approach through anterior border of tibialis posterior tendon combined with posterolateral approach in open reduction and internal fixation of Klammer typeⅡ/Ⅲposterior pilon variant fracture.Methods A retrospective case series study was conducted on 37 patients with posterior pilon variant fracture treated by posteromedial approach through anterior border of tibialis posterior tendon combined with posterolateral approach in Jiangsu Province People's Hospital and its Liyang branch between January 2015 and December 2019.There were 17 males and 20 females,aged 25-65 years[(49.5±9.3)years].Klammer classification was typeⅡin 20 patients and typeⅢin 17 patients.The quality of fracture reduction,incision healing and postoperative complications were observed.The loss of fracture reduction or implant failure was detected during the follow-up.The fracture union time was recorded.At the final follow-up,the residual pain was assessed by the visual analogue scale(VAS)and the ankle function by the American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score.Results All patients were followed up for 12-20 months[(15.6±1.2)months].An anatomic fracture reduction was observed in all patients,showing the incision healing by first intention.No skin necrosis,posteromedial neurovascular bundle injury,deep venous thrombosis,checkrein deformity or other complications occurred.During the follow-up,there was no reduction loss or implant failure.The fracture healing time ranged from 11 to 16 weeks[(13.2±1.4)weeks].At the final follow-up,the VAS was decreased from 6-9 points[(8.0±0.8)points]preoperatively to 0-2 points[(1.2±0.6)points](P<0.01).At the final follow-up,the AOFAS ankle-hindfoot score ranged from 80 to 100 points[(89.7±4.6)points],which showed excellent results in 15 patients and good in 22 patients,with the excellence rate of 100%.Conclusion The posteromedial approach through anterior border of tibialis posterior tendon combined with posterol
作者
刘波
乔之军
曹光华
朱华
杨光辉
秦晓东
Liu Bo;Qiao Zhijun;Cao Guanghua;Zhu Hua;Yang Guanghui;Qin Xiaodong(Department of Orthopedics,Liyang Branch of Jiangsu Province People's Hospital,Changzhou 213300,China;Department of Orthopedics,First Affiliated Hospital,Nanjing Medical University,Nanjing 210029,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2021年第12期1099-1104,共6页
Chinese Journal of Trauma
关键词
踝关节
骨折
骨折固定术
内
Ankle joint
Fractures,bone
Fracture fixation,interna
