摘要
目的探讨胫骨后pilon骨折的损伤机制，并评价不同内固定方式治疗胫骨后pilon骨折的临床疗效。方法回顾性分析自2012年1月至2015年1月收治的20例胫骨后pilon骨折的患者资料，男10例，女10例；年龄23-77岁，平均50．6岁；按照俞光荣分型：Ⅰ型5例，Ⅱa型3例，Ⅱb型4例，Ⅲ型7例，1例因无术前CT无法明确分型；受伤机制：平地滑倒2例，交通伤7例，下楼梯摔伤5例，运动伤2例，骑自行车摔伤1例，坠落伤3例（〉50cm）；13例患者骨折累及胫骨远端关节面大于25％，6例患者术中Cot—ton试验证实存在下胫腓联合分离。根据不同分型采用不同的内固定方法。术后采用Burwell—charnley放射学标准评价关节面的复位情况，采用Olerud—Molander踝关节评分和行走视觉模拟评分（VAS）评价患者踝关节功能。结果17例患者术后获6—36个月（平均17．8个月）随访。Burwell-Chamley放射学标准评价术后关节面复位情况：12例解剖复位，8例可，2例由前向后空心钉固定者内固定失效行翻修手术。17例患者末次随访时Olerud—Molander踝关节评分平均为81．5分（35-100分），行走VAS评分平均为1分（0-3分）。结论胫骨后pilon骨折多为中等能量或高能量损伤，为垂直暴力合并旋转暴力的共同作用结果。前向后空心拉力螺钉固定胫骨后pilon骨折失效几率较高，不建议采用；由后向前多枚空心钉、钢板联合空心钉固定的疗效满意。
Objective To explore the mechanisms of posterior pilon fractures and evaluate the curative effects of different types of fixation on the treatment of posterior pilon fractures. Methods We included in this retrospective study 20 patients with posterior pilon fracture who had been treated from January 2012 to January 2015 at our department. They were 10 men and 10 women, from 23 to 77 years of age （average, 50. 6 years） . According to the classification by Yu Guangrong, 5 cases belonged to type Ⅰ, 3 to type Ⅱa, 4 to type Ⅱb, and 7 to type Ⅲ. One was not indentified because of lacking CT examination. The mechanisms included ground level fall in 2 cases, motor vehicle accident in 7, fall off stairs in 5, sport injury in 2, fall from a bike in one and fall from a height in 3. More than 25% of the articular surface was involved in 13 patients. Syndesmosis injury was identified in 6 patients by Cotton test during operation. Internal fixation varied accordingly. We recorded the mechanism, classification, proportion of the articular surface involved （more or less than 25% ）, and syndesmosis injury to figure out the characteristics of posterior pilon fractures. We used the Burwell-Charnley radiographic criteria to assess the postoperative reduction of the articular surface, and the Olerud-Molander scoring scale and visual analogue scale （VAS） to assess the ankle function. The curative effects of different types of fixation on the treatment of posterior pilon fractures were compared. Results Of the 20 patients, 17 were available for follow-up for 6 to 36 months （average, 17.8 months）. Two patients received reoperation because of implant failure after cannulated screw fixation from anterior to posterior. The Burwell-Charnley radiographic evaluation revealed 12 anatoinical reducations and 8 fair reductions. The mean Olerud-Molander score for the 17 patients at the final follow-ups was 81.5 （range, from 35 to 100） and the mean walking VAS was 1 （from 0 to 3）. Conclusions Posterior pilon fractures are mostly caused by medium to high energy violence, resulting from a combination of rotational and vertical forces. Since there is a high risk of implant failure, the cannulated screw fixation from anterior to posterior is not recommended. Good clinical outcomes are observed in the cannulated screw fixation from posterior to anterior and the plate/cannulated screw fixation for posterior pilon fractures.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2016年第6期481-486,共6页
Chinese Journal of Orthopaedic Trauma
关键词
胫骨骨折
骨折固定术
内
治疗结果
Tibial fracture
Fracture fixation, internal
Treatment outcomes
