摘要
目的观察多轴锁定钢板内固定结合关节镜技术辅助治疗高能量Pilon骨折的疗效。方法自2010-02—2013-04诊治高能量Ruedi-AllgowerⅢ型Pilon骨折22例,利用CT三维重建骨折的形态及关节面情况,术中采用关节镜辅助观察胫距关节面并协助复位,然后用多轴锁定钢板固定胫骨远端碎骨折块。通过分析末次随访的踝关节影像学形态测量结果和踝关节功能Mazur评分评定术后疗效。结果 22例均获得随访10～24个月,平均13.3个月。骨折均获得愈合,愈合时间7～19周,平均11.4周。1例出现皮肤坏死,行转移皮瓣修复,其余无深部感染、骨折不愈合、钢板外露等并发症。末次随访时均行踝关节CT检查,仅1例CT显示胫骨远端关节面欠平整,但暂无骨性关节炎表现。疗效根据踝关节功能Mazur评分评定：优（〉92分）15例,良（87～92分）4例,可（65～86分）3例。结论多轴锁定钢板内固定结合关节镜技术治疗Ruedi-AllgowerⅢ型Pilon骨折具有手术创伤小、固定可靠、可早期功能锻炼、术后踝关节功能恢复好的优点。
Objective To observe the effect of polyaxial locking plate under arthroscopic surgery for treatment of high energy tibial Pilon fractures. Methods Twenty two cases of high energy Ruedi-Allgower Ⅲ type tibial pilon fractures were treated from Feb. 2010 to Apr. 2013. CT was used to reconstruct the morphology of fracture and articular surface. The articular surface of the tibia was observed and recovered under arthroscopic surgery. The distal tibial fracture fragment was fixed by polyaxial locking plate. Through the analysis of the last follow-up ankle radiographic morphometry results and ankle surgery Mazur score, the surgery efficacy was assessed. Results Twenty two cases were followed up for 10 to 24 months, with an average 13.3 months. All patients＇ fractures were healed from 7 to 19 weeks, with an average 11.4 weeks. One case had skin necrosis and flap surgery, the rest did not have deep infection, nonunion, plate exposure. The last follow-up CT showed only one of distal tibial articular surface less smooth, but without manifestations of osteoarthritis. According to Mazur score, 15 cases were excellent（score 92） and 4 cases good（score 87-92） and 3 cases acceptable（score 65-86）. Conclusion Polyaxial locking plate combined with arthroscopic surgery techniques to treat high energy Pilon fractures especially Ruedi-Allgower Ⅲhas the advantages such as good functional recovery of ankle joint after surgery, reliable fixation and early functional exercise.
出处
《中国骨与关节损伤杂志》
2015年第2期181-183,共3页
Chinese Journal of Bone and Joint Injury
