摘要
目的探讨采用延期切开复位内固定术治疗胫骨pilon骨折的临床疗效.方法1997年9月～2001年5月,利用石膏、绷带、跟骨牵引(闭合性骨折)或外固定支架(开放性骨折)行骨折临时固定,待伤后7～15 d,平均10.2 d,局部软组织损伤恢复后再行切开复位内固定术治疗胫骨pilon骨折26例,男19例,女7例;年龄15～58岁,平均37.5岁;开放性骨折6例,闭合性骨折20例,其中18例合并腓骨骨折.根据Ruedi-Allgower骨折分型:Ⅰ型2例,Ⅱ型15例,Ⅲ型9例.从踝关节功能评分和影像学两方面进行疗效评价.结果全部病例均获得随访,随访时间2～5.5年,平均3.8年.骨折愈合时间8～29周,平均12.7周.按Teeny等踝关节功能评分:优9例(34.6%),良12例(46.2%),可3例(11.5%),差2例(7.7%);优良率为80.8%.3例(11.5%)术后出现局部软组织并发症,包括2例切口感染和1例切口周缘皮肤坏死,均通过换药等局部处理后治愈.16例(61.5%)患者的踝关节X线片上有不同程度的退行性改变,但退变程度与临床评分无明显相关性.结论采用延期切开复位内固定的方法治疗胫骨pilon骨折,能有效地减少局部并发症并获得较好的踝关节功能.
Objective To analyze the results of distal tibial pilon fractures treated with delayed open reduction and internal fixation. Methods From September 1997 to May 2001, 26 pilon fractures were stabilized temporarily by application of plaster splint, bandage, calcaneal traction (closed fracture) or unilateral external fixations (open fracture) immediately after injury. There were 19 males and 7 females with an average age of 37.6 years ( 15 to 58 years). Of 26 cases, 6 were open fractures and 20 close fractures, 18 of which were associated with fibular fracture. According to Ruedi-Allgower classification, the fractures were classified as typeⅠin 2, typeⅡin 15, and typeⅢ in 9. The conditions of soft tissue were divided into mild close injury without tension vesicle in 8, and severe injury with tension vesicle or open wound in 18. The definitive internal fixations were performed on an average of 10.2 days (range, 7 to 15 days) after injury as soon as the soft tissue recovered. The final outcomes of treatment were evaluated based on clinical rating and radiographic results. Results All patients were available for follow-up at an average of 3.8 years (range, 2 to 5.5 years) after surgery. All fractures healed at an average of 12.7 weeks (range, 8 to 29 weeks) postoperatively. There were 9 excellent(34.6%), 12 good (46.2%), 3 fair (11.5%), and 2 poor (7.7%) results according the ankle score of Teeny and Wiss. The results were significantly affected by the type of fracture and the severity of soft tissue injury, the excellent and good rate was 88.2% in typeⅠandⅡ, and 66.7% in typeⅢ; the total excellent and good rate was 100% in the patients with mild soft tissue injury, and 72.2% in the patients with severe soft tissue injury. The complications including 2 wound superficial infection and 1 skin necrosis, occurred in 3 patients(11.5%), which were successfully treated by local dressing changes. The incidence of osteoarthritis were found in 16 patients (61.5%) showed by X-ray films, but the radiographic manifestations did not correspond well with the clinical score. Conclusion This two-stage treatment protocol for pilon fracture has some advantages of fewer complications and good function.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2004年第1期40-43,共4页
Chinese Journal of Orthopaedics
