摘要
目的探讨前侧pilon骨折的诊断、手术特点及临床疗效。方法回顾性分析2012年9月-2014年3月收治的前侧pilon骨折13例，均为新鲜闭合性骨折。平均年龄39．8岁（18～61岁）。致伤原因：高处坠落伤11例，摔伤2例。根据术前影像学表现及pilon骨折四柱分型，主要以前柱骨折为主。均行手术切开复位支撑钢板内固定，其中8例行同种异体骨植骨；末次随访采用美国足踝外科协会（AOFAS）踝-后足评分和视觉模拟评分（VAS）进行临床评估。结果13例均获随访，平均15．7个月（12-30个月）；平均AOFAS评分为91．38分（74～100分），其中优10例，良2例，中1例，优良率为92％。平均VAS为1．08分（0～3分）。出现创伤性关节炎1例；出现切口皮肤坏死1例，经换药治愈；未出现感染、骨折再移位及内固定失败等并发症。结论前侧pilon骨折的受伤机制为足背伸位垂直暴力所致，影像学特点以胫骨远端前侧关节面不同程度压缩骨折为主，多波及内踝前部，部分合并外踝骨折，属于高能量损伤；根据受伤机制及影像学表现可明确诊断；通过前方入路，行切开复位支撑钢板螺钉内固定＋同种异体骨植骨，可取得满意的临床疗效。
Objective To investigate the diagnosis, operation characteristics and clinical effect of anterior Pilon fracture. Methods A retrospective analysis was carried out to analyze 13 patients who had been treated for anterior pilon fracture from September 2012 to March 2014. All had fresh closed fracture. Mean age was 39.8 years （range, 18-61 years）. Injury resulted from high falls in 11 patients and falls in 2 patients. According to the preoperative imaging manifestations and four column fracture classification, the fracture type was mainly anterior column fracture. All underwent open reduction and internal fixation with buttress plates, and allograft bone was performed in 8 patients. At the last follow- up, American Orthopedic Foot and Ankle Society （AOFAS） ankle-hindfoot score and visual analogue scale （VAS） were employed for clinical evaluation. Results Mean period of follow-up was 15.7 months （range, 12-30 months）. Mean AOFAS score was 91.38 points （range, 74-100 points）. Excellent results were found in 10 patients, good in 2 and fair in 1, with the excellent-good rate of 92%. Mean VAS score was 1.08 points （ range, 0-3 points）. Traumatic arthritis occurred in 1 patient. Skin necrosis occurred in 1 patient, and was cured by dressing change. There were no complications such as infection, refracture or implant failure. Conclusions Mechanism of injury in anterior pilon fracture is vertical violence when the foot in dorsiflexion position. Imaging findings are mainly characterized by the compression in anterior articular surface of the distal tibia, which is often implicated in the anterior medial malleolus but in part is combined with lateral malleolus fracture. The fracture is the result of high energy injury, and can be diagnosed by mechanism of injury and imaging manifestations. Through anterior approach, open reduction and internal fixation with buttress plates plus allogenic bone grafting obtain satisfactory outcomes.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2016年第5期423-426,共4页
Chinese Journal of Trauma
关键词
胫骨骨折
踝损伤
骨折固定术
内
Tibial fractures
Ankle injuries
Fracture fixation, internal
