临时外固定结合二期切开复位内固定治疗复杂Pilon骨折的疗效分析
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摘要
目的探讨一期临时外固定结合二期切开复位内固定治疗复杂Pilon骨折的疗效。方法回顾性分析2014年12月至2017年12月首都医科大学宣武医院采用一期临时外固定架+二期切开复位内固定方式治疗的36例AO/OTAC1-C3型复杂Pilon骨折患者的临床资料。骨折术后复位情况采用Burwell-Charnley标准评定,末次随访时采用踝关节Mazur评分评估踝关节功能。结果 30例患者获得随访,平均随访14个月。术后骨折复位情况的Burwell-Charnley评定结果:解剖复位22例,复位可7例,复位差1例。骨折临床愈合时间平均4.2个月。末次随访踝关节功能的Mazur评分:平均85.2(56～93)分,优19例,良6例,可4例,差1例,优良率83.33%。术后1例出现切口浅表的感染,积极换药后愈合。结论复杂Pilon骨折采用一期临时外固定架二期切开复位内固定符合创伤控制原则,治疗效果满意。早期外固定架能为骨折提供良好稳定,有利于软组织条件的恢复,并为二期骨折的良好内固定创造有利条件。
Objective To investigate the effect of one-stage temporary external fixation and two-stage open reduction and internal fixation in the treatment of complex Pilon fracture. Methods From December 2014 to December 2017, 36 cases of AO/OTA C1-C3 complex Pilon fractures were retrospective analyzed. All patients underwent external fixation in the very early stage. Then it was replaced by strong internal fixation through open reduction when general conditions were controlled and the soft tissues improved. Both Burwell-Charnley classification and Mazur scoring of ankle were used to evaluate the fracture healing. Results Thirty patients were followed up for an average of 14 months. According to Burwell-Charnley classification, evaluation of postoperative fracture reduction results were 22 cases of anatomical reduction, 7 cases of acceptable reduction, and 1 case of poor reduction. The average clinical healing time was 4.2 months. At the last follow-up, the average Mazur score of ankle joint function was 85.2(56-93), 19 cases were excellent, 6 cases were good, 4 cases were fair, 1 case was poor, and the excellent and good rate was 83.33%. No nonunion occurred in this study, infection was found in one case which was cured by wound dressing and anti-infection treatment. Conclusions For complex Pilon fracture, external fixator in the early stage combined with open reduction and internal fixation in the late stage is a safe and effective way in the management of complex Pilon fractures.
Objective To investigate the effect of one-stage temporary external fixation and two-stage open reduction and internal fixation in the treatment of complex Pilon fracture. Methods From December 2014 to December 2017, 36 cases of AO/OTA C1-C3 complex Pilon fractures were retrospective analyzed. All patients underwent external fixation in the very early stage. Then it was replaced by strong internal fixation through open reduction when general conditions were controlled and the soft tissues improved. Both Burwell-Charnley classification and Mazur scoring of ankle were used to evaluate the fracture healing. Results Thirty patients were followed up for an average of 14 months. According to Burwell-Charnley classification, evaluation of postoperative fracture reduction results were 22 cases of anatomical reduction, 7 cases of acceptable reduction, and 1 case of poor reduction. The average clinical healing time was 4.2 months. At the last follow-up, the average Mazur score of ankle joint function was 85.2(56-93), 19 cases were excellent, 6 cases were good, 4 cases were fair, 1 case was poor, and the excellent and good rate was 83.33%. No nonunion occurred in this study, infection was found in one case which was cured by wound dressing and anti-infection treatment. Conclusions For complex Pilon fracture, external fixator in the early stage combined with open reduction and internal fixation in the late stage is a safe and effective way in the management of complex Pilon fractures.
引文
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[11]郑继会,胡思斌,邓海峰,等.复杂Pilon骨折的分期治疗[J].创伤外科杂志,2016,18:488-490.
[2]Bourne RB.Pylon fractures of the distal tibia[J].Clin Orthop Relat Res,1989,240:42-46.
[3]Rollo G,Filipponi M,Pichierri P,et al.Emergent and delayed hybrid external fixation management of tibial pilon fractures:a multicentric retrospective analysis of 80 patients[J].J Acute Dis,2017,6:169-174.
[4]Covey DC.Combat orthopaedics:a view from the trenches[J].J Am Acad Orthop Surg,2006,14:S10-S17.
[5]Bacon S,Smith WR,Morgan SJ,et al.A retrospective analysis of comminuted intra-articular fractures of the tibial plafond:open reduction and internal fixation versus external Ilizarov fixation[J].Injury,2008,39:196-202.
[6]Rüedi TP.Fractures of the lower end of the tibia into the ankle joint:results 9 years after open reduction and internal fixation[J].Injury,1973,5:130-134.
[7]Rüedi TP,Allg?wer M.The operative treatment of intra-articular fractures of the lower end of the tibia[J].Clin Orthop Relat Res,1979,138:105-110.
[8]Teeny SM,Wiss DA.Open reduction and internal fixation of tibial plafond fractures.Variables contributing to poor results and complications[J].Clin Orthop Relat Res,1993,292:108-117.
[9]Daghino W,Messina M,Filipponi M,et al.Temporary stabilization with external fixator in‘Tripolar’configuration in two steps treatment of tibial pilon fractures[J].Open Orthop J,2016,10:49-55.
[10]高伟,高堪达,陶杰,等.外固定支架在高能量Pilon骨折分期治疗中的价值探讨[J].中华危重症医学杂志(电子版),2008,1:84-87.
[11]郑继会,胡思斌,邓海峰,等.复杂Pilon骨折的分期治疗[J].创伤外科杂志,2016,18:488-490.