|
骨缝合结合锁定钢板内固定治疗合并腓骨骨折的C型Pilon骨折
|
Abstract:
目的:探讨经双切口采用骨缝合技术结合锁定钢板内固定治疗合并腓骨骨折的C型Pilon骨折的临床疗效。方法:回顾分析2018年01月至2022年01月我科运用骨缝合技术结合锁定钢板内固定治疗的13例合并腓骨骨折的C型Pilon骨折患者临床资料,其中男性患者8例,女性5例,平均年龄44.5岁。本组患者采用对部分破碎游离骨块进行骨缝合结合锁定钢板内固定治疗,术后定期复查并按医务人员指导进行功能锻炼,对患者治疗终末时骨折愈合及踝关节功能恢复情况进行分析。结果:13例患者骨折均实现临床愈合,愈合时间平均为6.54 ± 1.36月。1例患者出现创口局部坏死,部分钢板外露,经治疗后创口愈合,其余患者未出现皮肤坏死、骨折移位、严重感染、骨折不愈合并发症发生。治疗终末患者踝关节功能评定优6例,良6例,优良率92.31%。结论:经双切口采用骨缝合结合锁定钢板内固定治疗合并腓骨骨折的C型Pilon骨折,可简化手术过程,提高复位质量,可获得较好的治疗效果。
Objective: This paper aims to investigate the clinical effect by bone suture combined with locking plate internal fixation in the treatment of type C Pilon fracture complicated with fibula fracture. Methods: From January 2018 to January 2022, 13 patients (8 males, 5 females; mean age 44.5 years) with type C Pilon fracture complicated with fibula fracture treated by bone suture combined with locking plate internal fixation were retrospectively analyzed. Regular follow-up examinations and functional exercises were performed after surgery. The recovery of ankle joint function and fracture healing time were analyzed. Results: The mean time to fracture healing was 6.54 ± 1.36 months. One patient had skin necrosis and part of the plate was exposed, and the wound healed after careful treatment finally. The other patients did not have serious soft tissue infection, fracture displacement, osteomyelitis, fracture nonunion, or other complications. At the end of treatment, functional outcomes were excellent in 6, and good in 6. The excellent and good rate of functional results was 92.31%. Conclusion: Bone suture combined with locking plate internal fixation is a simple and effective method for the treatment of type C Pilon fracture with fibula fracture, and it could obtain better therapeutic effect.
[1] | Destot, E.A.J. (1911) Traumatismes du pied et rayons X: Malleoles-astragale-calcaneum-avant-pied. Masson, Par-is. |
[2] | 张宪高. 影响Pilon骨折分型的相关因素研究[D]: [硕士学位论文]. 唐山: 华北理工大学, 2021. |
[3] | 钱锦锋, 黄伟, 曾忠友. Pilon骨折术后并发症的发生率与相关因素分析[J]. 中华全科医学, 2023, 21(3): 417-419. |
[4] | Azar, F.M., Beaty, J.H., Canale, S.T. 坎贝尔骨科手术学[M]. 第13版. 唐佩福, 王岩, 卢世璧, 译. 北京: 北京大学医学出版社, 2018: 2560-2574. |
[5] | 曾炳芳, 张长青. 2004创伤骨科新进展[M]. 北京: 人民卫生出版社, 2003: 777. |
[6] | Barei, D.P., Nork, S.E., Bellabarba, C., et al. (2006) Is the Absence of an Ipsilateral Fibular Fracture Predictive of Increased Radiographic Tibial Pilon Fracture Severity? Journal of Orthopaedic Trauma, 20, 6-10.
https://doi.org/10.1097/01.bot.0000189589.94524.ff |
[7] | McFerran, M.A., Smith, S.W., Boulas, H.J., et al. (2008) Complicaations Encountered in the Treatment of Pilon Fractures. Journal of Orthopaedic Trauma, 22, 451-457. |
[8] | Kummer, A., Cadas, H. and Crevoisier, X. (2021) Posterior to Anterior Malleolar Extended Lateral Approach to the Ankle (PAMELA): A Cadaveric Anatomic Study. Archives of Orthopaedic and Trauma Surgery, 141, 427-435.
https://doi.org/10.1007/s00402-020-03507-2 |
[9] | Zelle, B.A., Dang, K.H. and Ornell, S.S. (2019) High-Energy Tibial Pilon Fractures: An Instructional Review. International Orthopaedics, 43, 1939-1950. https://doi.org/10.1007/s00264-019-04344-8 |
[10] | Kottmeier, S.A., Madison, R.D. and Divaris, N. (2018) Pilon Fracture: Preventing Complications. Journal of the American Academy of Orthopaedic Surgeons, 26, 640-651. https://doi.org/10.5435/JAAOS-D-17-00160 |
[11] | Bhattacharyya, T., Crichlow, R., Gobezie, R., et al. (2006) Complications Associated with the Posterolateral Approach for Pilon Fractures. Journal of Orthopaedic Trauma, 20, 104-107.
https://doi.org/10.1097/01.bot.0000201084.48037.5d |
[12] | Deivaraju, C., Vlasak, R. and Sadasivan, K. (2015) Staged Treatment of Pilon Fractures. Journal of Orthopaedics, 12, S1-S6. https://doi.org/10.1016/j.jor.2015.01.028 |
[13] | Cui, X., Chen, H., Rui, Y., et al. (2018) Two-Stage Open Re-duction and Internal Fixation versus Limited Internal Fixation Combined with External Fixation: A Meta-Analysis of Postoperative Complications in Patients with Severe Pilon Fractures. Journal of International Medical Research, 46, 2525-2536. https://doi.org/10.1177/0300060518776099 |
[14] | 王智祥, 魏世隽, 蔡贤华. 胫骨Pilon骨折分型现状[J]. 中国矫形外科杂志, 2018, 26(6): 533-537. |
[15] | 余进伟, 陈豪杰, 张雁儒, 等. 新型Pilon钢板治疗C型Pilon骨折的疗效研究[J]. 中国修复重建外科杂志, 2023, 37(1): 31-36. |
[16] | 史舅生, 孔磊, 尹若丰, 等. 临时骨牵引外固定架固定与切开复位内固定分期手术治疗高能量Pilon骨折疗效观察[J]. 中国骨与关节损伤杂志, 2022, 37(10): 1098-1100. |