应用胫骨远端解剖接骨板并植骨治疗Pilon骨折
摘要
目的:观察应用胫骨远端解剖接骨板并植骨治疗Pilon骨折的临床效果。为临床治疗提供参考,丰富关节外科学的内容。通过胫骨远端解剖接骨板并植骨在Pilon骨折的应用研究,为临床应用提供依据。
方法:自2005年2月～2007年12月应用胫骨远端解剖接骨板并植骨治疗Pilon骨折28例,Pilon骨折根据Rudei Allgower分型Ⅰ型0例,Ⅱ型18例,Ⅲ型10例。随访结果按Helfet评分标准进行功能评价。根据治疗前后的x线片资料和随访结果,对Pilon骨折应用胫骨远端解剖接骨板并植骨治疗的临床效果进行分析。
结果:术后随访4～36个月,平均23个月,无骨折不愈合或畸形愈合,无骨髓炎,无肢体缩短。按Helfet评分标准进行功能评价:Ⅱ型损伤18例,优15例,良2例,差1例,优良率为94.44%;Ⅲ型损伤10例,优6例,良2例,差2例,优良率为80%;总优良率为8928%。
结论:根据AO观点,软组织覆盖状态是影响Pilon骨折的决定因素之一。选择适当的手术时机应用较薄的解剖接骨板治疗Pilon骨折可有效减少发生伤口感染、皮肤缺损、溃烂等软组织并发症;对缺损的骨空腔植骨不但有效避免骨折延迟愈合和不愈合,还可减少关节面再塌陷而造成的内固定不稳及创伤性关节炎;胫骨远端解剖接骨板设计特点适合于所有类型Pilon骨折固定需要能起到坚强的固定作用,可早期活动踝关节,避免关节僵硬及延缓创伤性关节炎的发生。选择适当的手术时机应用胫骨远端解剖接骨板并植骨是治疗Pilon骨折的有效方法之一。
Objective:To investigate the anatomy of the distal tibial plate and bone fracture treatment of the clinical effects of Pilon.Provide reference for the clinical treatment,and enrich the contents of joint surgery.Through the anatomy of the distal tibia bone plate and Pilon fracture in applied research,provide the basis for clinical application.
Methods:From February 2005 to December 2007 anatomy of the distal tibial plate and bone fracture treatment Pilon 28 cases,Pilon fracture under Rudei Allgower Type 0 cases of typeⅠ,18 patients with TypeⅡ,Ⅲ10 cases.Follow-up results by Helfet score standards for functional evaluation.According to the treatment before and after the x-ray data and follow-up results of Pilon fracture anatomy of the distal tibia bone plate and the clinical effects of treatment were analyzed.
Results:The follow-up of 4 to 36 months,with an average 23 months, non-union or without fracture malunion,without osteomyelitis,a shortened limbs.Helfet score on the functional evaluation criteria:TypeⅡinjury in 18 cases,excellent in 15 cases,good in two cases,one case of poor,good rate of 94.44%;Ⅲ10 cases of injury,gifted six cases, good in 2 cases,and poor in 2 cases,excellent rate of 80 per cent;total rate of 89.28%fine.
Conclusion:According to AO perspective,soft tissue coverage is the impact of the state's decision Pilon fracture one of the factors.Select the appropriate timing of the anatomy of thin steel plate for Pilon fractures can effectively reduce the incidence of wound infection,skin defects,ulcers,and other soft tissue complications of bone defect in the bone cavity not only effective way to avoid the delayed fracture healing and healing,but also further reduce the articular surface subsidence caused by the instability and internal fixation of traumatic arthritis;anatomy of the distal tibial plate design features suitable for all types of Pilon fracture fixation need to be able to play a strong role in the fixed,ankle early activities,and avoid joint stiffness and retard the occurrence of traumatic arthritis.Select the appropriate timing of surgery anatomy of the distal tibial plate and bone fracture treatment Pilon one of the effective methods.
方法:自2005年2月～2007年12月应用胫骨远端解剖接骨板并植骨治疗Pilon骨折28例,Pilon骨折根据Rudei Allgower分型Ⅰ型0例,Ⅱ型18例,Ⅲ型10例。随访结果按Helfet评分标准进行功能评价。根据治疗前后的x线片资料和随访结果,对Pilon骨折应用胫骨远端解剖接骨板并植骨治疗的临床效果进行分析。
结果:术后随访4～36个月,平均23个月,无骨折不愈合或畸形愈合,无骨髓炎,无肢体缩短。按Helfet评分标准进行功能评价:Ⅱ型损伤18例,优15例,良2例,差1例,优良率为94.44%;Ⅲ型损伤10例,优6例,良2例,差2例,优良率为80%;总优良率为8928%。
结论:根据AO观点,软组织覆盖状态是影响Pilon骨折的决定因素之一。选择适当的手术时机应用较薄的解剖接骨板治疗Pilon骨折可有效减少发生伤口感染、皮肤缺损、溃烂等软组织并发症;对缺损的骨空腔植骨不但有效避免骨折延迟愈合和不愈合,还可减少关节面再塌陷而造成的内固定不稳及创伤性关节炎;胫骨远端解剖接骨板设计特点适合于所有类型Pilon骨折固定需要能起到坚强的固定作用,可早期活动踝关节,避免关节僵硬及延缓创伤性关节炎的发生。选择适当的手术时机应用胫骨远端解剖接骨板并植骨是治疗Pilon骨折的有效方法之一。
Objective:To investigate the anatomy of the distal tibial plate and bone fracture treatment of the clinical effects of Pilon.Provide reference for the clinical treatment,and enrich the contents of joint surgery.Through the anatomy of the distal tibia bone plate and Pilon fracture in applied research,provide the basis for clinical application.
Methods:From February 2005 to December 2007 anatomy of the distal tibial plate and bone fracture treatment Pilon 28 cases,Pilon fracture under Rudei Allgower Type 0 cases of typeⅠ,18 patients with TypeⅡ,Ⅲ10 cases.Follow-up results by Helfet score standards for functional evaluation.According to the treatment before and after the x-ray data and follow-up results of Pilon fracture anatomy of the distal tibia bone plate and the clinical effects of treatment were analyzed.
Results:The follow-up of 4 to 36 months,with an average 23 months, non-union or without fracture malunion,without osteomyelitis,a shortened limbs.Helfet score on the functional evaluation criteria:TypeⅡinjury in 18 cases,excellent in 15 cases,good in two cases,one case of poor,good rate of 94.44%;Ⅲ10 cases of injury,gifted six cases, good in 2 cases,and poor in 2 cases,excellent rate of 80 per cent;total rate of 89.28%fine.
Conclusion:According to AO perspective,soft tissue coverage is the impact of the state's decision Pilon fracture one of the factors.Select the appropriate timing of the anatomy of thin steel plate for Pilon fractures can effectively reduce the incidence of wound infection,skin defects,ulcers,and other soft tissue complications of bone defect in the bone cavity not only effective way to avoid the delayed fracture healing and healing,but also further reduce the articular surface subsidence caused by the instability and internal fixation of traumatic arthritis;anatomy of the distal tibial plate design features suitable for all types of Pilon fracture fixation need to be able to play a strong role in the fixed,ankle early activities,and avoid joint stiffness and retard the occurrence of traumatic arthritis.Select the appropriate timing of surgery anatomy of the distal tibial plate and bone fracture treatment Pilon one of the effective methods.
引文
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[3]Evan H,Lon S.Displaced.Pilon fractures.Orthop Clin Nor Am,1994,25(4):615
[4]Pugh ILl,Wolinsky PR,McAndrw MP.et al.Tibial Pilon fractures:a cam parisn of treatment methods[J].J Trauma。 1999。 47:937-941
[5]Kellam J,Waddell J.Fractures of the distal tibial metaDhysiswith intra-articualr extension-the distal tibial explosion frac-ture[J].J Trauma,1979,19:593
[6]吴泉州,蒋盛旦,徐荣明.胫骨Pilon骨折.骨与关节损伤杂志,2004,19:646.648.
[7]Tracy Watson J,Moed BR,Karges DE,et al.Pilon fracture treatment protocol based on severity of soft tissue injury.Clin Orthop,2000,375(6):78-90
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