摘要
目的探讨经皮克氏针胫距跟临时固定在急性闭合性不稳定踝关节骨折“损害控制”应用中的安全性与有效性。方法回顾性分析2018年6月—2022年3月江门市中心医院运动医学与足踝外科采用经皮克氏针胫距跟临时固定技术进行“损害控制”的23例急性闭合性不稳定踝关节骨折患者,男性13例,女性10例;年龄18~78岁,平均44.6岁。跌倒扭伤7例,运动伤5例,道路交通伤7例,高处坠落伤4例。Tscherne分型Ⅰ级8例,Ⅱ级8例,Ⅲ级7例。C型臂X线机下手法复位,于足底经皮从远端向近端跨胫距跟关节纵向置入1枚2.5 mm及1枚2.0 mm克氏针。记录患者从Ⅰ期克氏针固定手术至Ⅱ期内固定手术的天数及出现相关并发症的情况,术后12个月随访记录足踝结局评分(FAOS)。结果本组患者均未发生皮肤坏死、针道感染、切口愈合不良等并发症,Ⅱ期内固定等候天数为(9.5±2.5)d,术后12个月FAOS为(85.8±4.6)分。结论经皮克氏针胫距跟固定应用于急性闭合性不稳定踝关节骨折是一种经济、有效、安全并适宜推广的“损害控制”手段。
Objective To explore the safety and effectiveness of percutaneous K-wire tibiotalocalcaneal temporary fixation for“damage control”of acute closed unstable ankle fractures.Methods A retrospective analysis was conducted on 23 patients with acute closed unstable ankle fractures treated with percutaneous K-wire tibiotalocalcaneal temporary fixation between Jun.2018 and Mar.2022.This case series included 13 males and 10 females aged 18-78(mean 44.6)years,with 7 fall-related sprains,5 sports injuries,7 road traffic injuries and 4 falls from height.Tscherne classifications showed 8 cases of gradeⅠ,8 gradeⅡand 7 gradeⅢ.A manual reduction was performed under C-arm fluoroscopy;then a 2.5-mm and another 2.0-mm K-wire were percutaneously inserted longitudinally from distal to proximal across the tibiotalocalcaneal joint at the sole.The duration from the initial K-wire fixation to the second-stage internal fixation surgery was recorded,together with the incidence of related complications and the Foot and Ankle Outcome Score(FAOS)at 12-month follow-up.Results None of the patients developed complications such as skin necrosis,pin tract infection or poor wound healing.Patients waited for(9.5±2.5)days to receive internal fixation surgery,and the 12-month postoperative FAOS score was 85.8±4.6.Conclusion Percutaneous K-wire tibiotalocalcaneal temporary fixation in the management of acute closed unstable ankle joint fractures is cost-effective and safe,and we recommend it for emergent“damage control”.
作者
罗裕强
马滚韶
徐勤
罗焕
Luo Yuqiang;Ma Gunshao;Xu Qin;Luo Huan(Department of Sports Medicine and Foot&Ankle Surgery,Jiangmen Central Hospital,Jiangmen,Guangdong Province 529100,China)
出处
《创伤外科杂志》
2024年第4期267-271,278,共6页
Journal of Traumatic Surgery
关键词
踝关节骨折
损害控制
克氏针固定
Unstable ankle fractures
Damage control
K-wire fixation
