摘要
目的旨在建立一种基于损伤机制的胫骨Pilon骨折改良分型方法,并评估应用该分型策略的临床效果。方法对作者医院2008-08/2013-08月收治的151例胫骨Pilon骨折患者的损伤机制及影像学资料进行分析,按照受伤时踝关节所处位置以及骨折初始移位方向分为五种类型:内翻型、外翻型、背伸型、跖屈型、中立位型。依据原始移位方向及骨折线和骨折块分布情况选择相应的手术切口和固定方式,121例患者术后获得完整随访资料,按照AO/OTA分型,其中B型54例(44.6%),C型67例(55.4%)。术后应用Teeny and Wiss’s评分系统评估骨折复位质量,末次随访时应用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分标准进行功能评价。结果术后获得12~36个月随访(平均22.1个月)。其中119例术后如期获得骨折愈合,2例延迟愈合(外翻型1例,中立位型1例)通过二期植骨最终获得愈合;并发症主要集中在外翻型和中立位型。按照Teeny and Wiss’s评分系统,109例(90%)获得了理想的骨折复位(包括解剖复位和良好复位)。末次随访平均AOFAS评分达86.3分。即使在损伤程度较为严重的中立位组,理想的复位率也达到了72.7%,末次随访平均AOFAS评分也达到了78.7分。末次随访时未观察到内固定失败。结论基于损伤机制的胫骨Pilon骨折综合法分型及对应的手术策略可能具有一定的潜在优势:增加骨折复位的准确性,减少软组织并发症和固定失败率。
Objective To establish an advanced classification method for tibia Pilon fracture based on injury mechanism and evaluate the clinical curative effects of this kind of surgical strategy.Methods A total of 151 patients with tibia Pilon fracture who were admitted in authors' hospital from August 2008 to August 2011 were analyzed for injury mechanism and imaging data.These patients were divided into 5 groups according to the location of injured ankle or initial displacement of fracture:Varus group,Valgus group,Dorsalflexion group,Plantarflexion group,and Neutral position group.Surgical incision and fixation were selected according to initial displacement and distribution of fracture line and fracture segments.121 patients were followed up for 22.1 months in average.According to the AO/OTA classification,there were 54 type B(44.6%)and67type C(55.4%).Clinical and imaging outcome of each case was evaluated.Teeny and Wiss' s scale was used to evaluate reduction quality of the fracture.The functional evaluations were conducted by the AOFAS ankle-hindfoot scale.Results All cases were followed up for 12-36 months(average 22.1 months),where 119 cases were healed after operation,2 cases appeared healing delay(1 case of Vaglus group and1 case of Neutral group)and finally cured by bone grafting.The complications were mainly centered at Vaglus group and Neutral group.According to Teeny and Wiss' s scale,109 cases(90%)achieved goal reduction(including anatomical reduction and adequate reduction).At last follow-up after operation,AOFAS score achieved 86.3 points.Even in the Neutral group,the injury of which was relatively more serious,reduction rate also reached 72.7%,and mean AOFAS score was up to 78.7 points.Failure of internal fixation was not observed at last follow-up.Conclusion The modified classification for Pilon fracture based on injury mechanism and corresponding surgery strategy may have potential advantages:including increasing accuracy of fracture reduction and stability as well as reducing complications of soft tissue.
出处
《华南国防医学杂志》
CAS
2015年第3期185-191,共7页
Military Medical Journal of South China
基金
武汉市中青年医学骨干人才培养工程资助项目(武卫生计生[2014]77号)
关键词
PILON骨折
胫骨远端骨折
损伤机制
分型
Pilon fracture
Distal tibial fracture
Injury mechanism
Classification
