前外侧单切口结合“L”型锁定钢板治疗Pilon骨折30例
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摘要
目的探讨小腿前外侧单切口结合胫骨远端前外侧"L"型锁定钢板治疗Pilon骨折的临床疗效。方法回顾性分析2010年9月至2017年12月在联勤保障部队第九OO医院骨一科手术治疗并获得随访的30例Pilon骨折患者的临床资料,30例患者中交通事故伤17例,高处坠落伤9例,重物砸伤4例。开放性骨折6例,闭合性骨折24例。骨折按Ruedi-Allgower分类方法:Ⅱ型25例;Ⅲ型5例。结果术后平均随访6～12个月;按Mazur评分系统,随访的30例患者中优23例,良5例,优良率为93.3%;2例术后出现切口感染,皮肤部分坏死,骨钢板外露,均在术后2周左右行穿支蒂隐神经营养血管皮瓣转移术,术后皮瓣成活。结论采用前外侧单切口结合胫骨远端"L"型锁定钢板治疗Pilon骨折可获得良好的显露,满意的复位,坚强的固定,并且避免在小腿前内侧的皮肤作切口,为可能的二期皮瓣移植保存供区,取得优良的治疗效果。
Objective To explore the clinical efficiency of anterolateral single incision combined with "L" type locking plate in the treatment of Pilon fracture. Methods A retrospective analysis was performed on the clinical data of 30 patients with Pilon fracture, who underwent surgical treatment in the First Department of Orthopaedic at the 900 thHospital of PLA Joint Logistic Support Force and were followed up from September 2010 to December 2017. Among the 30 patients, 17 were injured for traffic accidents, 9 for high falls, and 4 for heavy objects. There were 6 open fractures and 24 closed fractures. According to the Rüedi-Allg?wer classification, these fractures were classified in type Ⅱ(25 cases)and type Ⅲ(5 cases). Results The average follow-up was 6 months to 12 months. According to the Mazur scoring system, 23 of the 30 patients who were followed up were excellent, and 5 of them were good; the excellent and good rate was 93.3%. There were 2 patients who developed postoperative wound infections, partial skin necrosis, and bone plate exposure. They both were transferred with perforator pedicle saphenous neurovascular flap at about 2 weeks after surgery, and all flaps survived. Conclusion The use of the anterolateral single incision combined with "L" type locking plate in the treatment of Pilon fracture can achieve good exposure, satisfactory reduction, strong fixation, and avoid a skin incision in the anteromedial side of the lower leg, preserve the donor area for the possible second-stage skin flap transplantation, and obtain excellent therapeutic effect.
Objective To explore the clinical efficiency of anterolateral single incision combined with "L" type locking plate in the treatment of Pilon fracture. Methods A retrospective analysis was performed on the clinical data of 30 patients with Pilon fracture, who underwent surgical treatment in the First Department of Orthopaedic at the 900 thHospital of PLA Joint Logistic Support Force and were followed up from September 2010 to December 2017. Among the 30 patients, 17 were injured for traffic accidents, 9 for high falls, and 4 for heavy objects. There were 6 open fractures and 24 closed fractures. According to the Rüedi-Allg?wer classification, these fractures were classified in type Ⅱ(25 cases)and type Ⅲ(5 cases). Results The average follow-up was 6 months to 12 months. According to the Mazur scoring system, 23 of the 30 patients who were followed up were excellent, and 5 of them were good; the excellent and good rate was 93.3%. There were 2 patients who developed postoperative wound infections, partial skin necrosis, and bone plate exposure. They both were transferred with perforator pedicle saphenous neurovascular flap at about 2 weeks after surgery, and all flaps survived. Conclusion The use of the anterolateral single incision combined with "L" type locking plate in the treatment of Pilon fracture can achieve good exposure, satisfactory reduction, strong fixation, and avoid a skin incision in the anteromedial side of the lower leg, preserve the donor area for the possible second-stage skin flap transplantation, and obtain excellent therapeutic effect.
引文
[1]段锐. L型锁定板联合外固定架在Pilon骨折中的应用分析[J].河南医学研究, 2013, 22(2):228-229.
[2]秦荣毫. L型解剖锁定加压接骨板固定对胫骨Pilon骨折患者术后骨折愈合及踝关节功能的影响[J].河南医学研究, 2018, 27(21):3962-3963.
[3]程永涛,唐眏利,袁生华,等.急诊严重多发伤合并骨与关节损伤应用损伤控制技术治疗的效果分析[J].中国骨与关节损伤杂志,2016, 31(11):1167-1170.
[4] LAU TW, LEUNG F, CHAN CF, et al. Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures[J]. Int Orthop, 2008, 32:697-703.
[5] WEBER M. Trimalleolar fractures with impaction of the posteromedial tibial plafond:implications for talar stability[J]. Foot Ankle Int,2004, 25(10):716-727.
[6]张继锋.切开复位内固定与有限内固定结合外固定治疗胫骨Pilon骨折[J].实用中西医结合临床, 2017, 17(4):73-74.
[7]丁华东,周志华.胫骨远端锁定加压钢板与解剖型钢板内固定治疗Pilon骨折疗效比较[J].海南医学, 2017, 28(19):3141-3143.
[8]陆建华,刁振鸿.“L”型锁定钢板微创治疗胫骨远端近关节骨折[J].实用骨科杂志, 2012, 18(2):166-168.
[9]张远成,何磊,韩立民,等.锁定钢板微创固定治疗胫骨pilon骨折[J].中华创伤骨科杂志, 2012, 14(1):88-89.
[10] LIPORACE FA, YOON RS. An adjunct to percutaneous plate insertion to obtain optimal sagittal plane alignment in the treatment of pilon fractures[J]. J Foot Ankle Surg, 2012, 51(2):275-277.
[2]秦荣毫. L型解剖锁定加压接骨板固定对胫骨Pilon骨折患者术后骨折愈合及踝关节功能的影响[J].河南医学研究, 2018, 27(21):3962-3963.
[3]程永涛,唐眏利,袁生华,等.急诊严重多发伤合并骨与关节损伤应用损伤控制技术治疗的效果分析[J].中国骨与关节损伤杂志,2016, 31(11):1167-1170.
[4] LAU TW, LEUNG F, CHAN CF, et al. Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures[J]. Int Orthop, 2008, 32:697-703.
[5] WEBER M. Trimalleolar fractures with impaction of the posteromedial tibial plafond:implications for talar stability[J]. Foot Ankle Int,2004, 25(10):716-727.
[6]张继锋.切开复位内固定与有限内固定结合外固定治疗胫骨Pilon骨折[J].实用中西医结合临床, 2017, 17(4):73-74.
[7]丁华东,周志华.胫骨远端锁定加压钢板与解剖型钢板内固定治疗Pilon骨折疗效比较[J].海南医学, 2017, 28(19):3141-3143.
[8]陆建华,刁振鸿.“L”型锁定钢板微创治疗胫骨远端近关节骨折[J].实用骨科杂志, 2012, 18(2):166-168.
[9]张远成,何磊,韩立民,等.锁定钢板微创固定治疗胫骨pilon骨折[J].中华创伤骨科杂志, 2012, 14(1):88-89.
[10] LIPORACE FA, YOON RS. An adjunct to percutaneous plate insertion to obtain optimal sagittal plane alignment in the treatment of pilon fractures[J]. J Foot Ankle Surg, 2012, 51(2):275-277.