单纯内固定与有限内固定结合外固定在治疗高能量闭合性pilon骨折中的比较

doi:j.issn.1009-976X.2013.02.010

摘要/Abstract

摘要：

【摘要】目的 比较单纯内固定与有限内固定结合外固定在治疗高能量闭合性pilon骨折中的临床效果,评估两种术式在治疗高能量闭合性Pilon骨折中的优劣。方法回顾性分析2001年12月至2010年12月收治的42例高能量闭合性Pilon骨折的临床资料。按手术方式不同分为两组:A组26例,行切开复位单纯内固定手术(ORIF);B组16例,行切开复位有限内固定结合外固定手术(LORIF+ EX)。分析术后两组患者感染、骨延迟愈合或不愈合、创伤性关节炎、关节僵硬等并发症的发生率,测量术后8个月患者关节活动度并根据AOFAS评分标准评价其踝足功能。结果术前两组患者在性别、年龄、骨折分型、受伤至手术时间等方面无明显差异(P>0.05),术后随访8~109月个月,平均 37.6个月,两种治疗方法在术后并发症发生率、关节活动度及AOFAS评分并无明显差别(P>0.05)。结论对于高能量闭合性pilon骨折的治疗,切开复位内固定和切开复位有限内固定结合外固定临床疗效相当,并发症的发生率无明显差别,均可作为其治疗手段。

关键词: Pilon骨折, 内固定, 外固定, 疗效

Abstract:

【Abstract】Objective To compare the clinical outcomes of high-energy closed pilon fracture treated with simple internal fixtion and limited internal fixtion combined with external fixtion. Methods From Dec. 2001 to Dec. 2010,the clinical data of 42 cases with high-energy closed pilon fracture were analyzed retrospectively..According to the surgical methods,.these patients were divided into two groups. Group A were treated by open reduction and simple internal fixtion(ORIF) in 26 cases,.and Group B were treated by open reduction and limited internal fixtion combined external fixtion (LORIF plus EX) in 16 cases..The incidence of post-operative complications were statistically analyzed,.including infection,.bone delayed union,.traumatic arthritis,.ankylosis and the range of ankle activity and the function were measured according to AOFAS hindfoot score system 8 months after operation. Results No significant difference were found between two groups in gender,.age, fracture type, time from injury to surgery (P>0.05)..The patients were followed up for 8-109 months,average 37.6 months..The differences of the two methods were no differences in the incidence rate of postoperative complications and the articular activity and AOFAS scores of ankle. Conclusions For the treatment of high-energy closed Pilon fracture,.the curative effects of ORIF and ORIF plus EX were similar and postoperative complications were no diffferences. But for the pilon fracture associated with severe soft tissue injury, ORIF plus EX is a better choice.

Key words: Pilon fracture, Internal fixation, External fixation, Curative effects

中图分类号:

R683.41

侯念宗陈炳豪洪劲松陈皓刘文宙宋卫东. 单纯内固定与有限内固定结合外固定在治疗高能量闭合性pilon骨折中的比较[J]. 岭南现代临床外科, 2013, 13(02): 113-116.

Hou Nianzong, Chen Binghao, Hong Jingsong, Chen Hao, Liu Wenzhou, Song Weidong. Comparision between simple internal fixtion and limited internal fixtion combined with external fixtion for treatment of high?鄄energy closed pilon fracture[J]. Lingnan Modern Clinics in Surgery, 2013, 13(02): 113-116.

参考文献

[1] 赵程, 张树明, 杨润功.三种方式治疗高能量Pilon 骨折的临床评价.中国创伤骨科杂志, 2001, 3: 24-26.
[2] Blauth M, Bastian L, Krettek C, et al. Surgical options for the treatment of severe tibial pilon fractures:a study of three techniques. J Orthop Trauma, 15: 153-160.
[3] Mandracchia VJ, Evans RD, Nelson SC, et al. Pilon fractures of the distal tibia. Clin Podiatr Med Surg, 1999, 16: 743-767.
[4] 何健飞姜世平王建云,等. 手术治疗PiIon 骨折的难点及对策. 岭南现代临床外科,2010,12(4):369-370.
[5] Burwell HN, Charnley AD. The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg Br, 1965, 47: 634-660.
[6] Syed MA，Panchbhavi VK.Fixation of tibial pilon fractures with percutaneous cannulated screws. Injury, 2004，35：284-289.
[7] Tarkin IS, Clare MP, Marcantonio A, et al. An update on the management of high-energy pilon fractures. Injury, 2008, 39:142-154.
[8] Patterson MJ, Cole JD. Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma, 1999, 13: 85-91.
[9] 谢广渊,唐国华. pilon骨折合并颅脑损伤骨折固定手术时机的探讨. 岭南现代临床外科,2010,10(2):121-122.
[10] Pugh KJ, Wolinsky PR, McAndrew MP, et al. Tibial Pilon Fractures: A Comparison of Treatment Methods. J Trauma-Injury Infection & Critical Care, 1999, 47: 937
[11] Mandi DM, Belin RP, Banks J, et al. Pilon Fractures. Clin Podiatr Med Surg, 2012, 29: 243-278.
[12] DeFranzo AJ, Argenta LC, Marks MW, et al. The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone. Plastic & Reconstructive Surgery, 2001, 108: 1184-1191.
[13] Wyrsch B, McFerran MA, McAndrew M,et al. Operative treatment of fractures of the tibial plafond. A randomized, prospective study. J Bone Joint Surg Am, 1996, 78: 1646-1657.
[14]周雄清,叶运廷,李亦明,等. 治疗骨骺未闭Pilon骨折的临床研究. 岭南现代临床外科,2010,6(4):304-305,310.

[1]	张育周, 张俊鑫, 徐煜宇, 陈双星, 徐桂彬. 球囊扩张术联合双根D-J管在治疗良性输尿管狭窄中的疗效分析[J]. 岭南现代临床外科, 2021, 21(03): 345-348.
[2]	周克燕, 胡景辉, 刘东彪, 文健辉, 关飞. 聚桂醇局部注射对不同年龄和部位小儿血管瘤的疗效分析[J]. 岭南现代临床外科, 2021, 21(02): 200-203.
[3]	龙文浩, 蓝映, 封帆, 王伟明, 苏奕轩. 残留软骨切下回植治疗手外伤后指间关节部分软骨缺损的临床疗效[J]. 岭南现代临床外科, 2021, 21(01): 117-119.
[4]	李洪彬, 刘楠. 关节置换术治疗老年无移位股骨颈骨折合理性Meta分析[J]. 岭南现代临床外科, 2020, 20(06): 766-770.
[5]	黄开越, 常冀杨, 李健, 徐闯, 曹恒, 王林伟, 张立超, 刘明廷. 体外冲击波治疗与手术治疗骨折延迟愈合临床疗效对比分析[J]. 岭南现代临床外科, 2020, 20(05): 588-592.
[6]	钱军, 林健, 苏树远. C臂透视下股骨粗隆间骨折闭合复位空心拉力钉内固定术：88例基层医院经验报告[J]. 岭南现代临床外科, 2020, 20(05): 593-596.
[7]	萧锦瑜, 叶记超, 王振. 椎体成形术治疗胸腰椎内固定术后置钉椎压缩性骨折疗效观察[J]. 岭南现代临床外科, 2020, 20(05): 601-604.
[8]	郑伟坤, 汤俊芬, 戈涛, 蔡维山. 肘关节恐怖三联征中桡骨小头HotchkissⅢ型骨折的处理策略选择：内固定或置换?[J]. 岭南现代临床外科, 2020, 20(04): 496-502.
[9]	梁华, 张飞, 罗宜轩. 腔镜不停跳术对左心瓣膜置换术后远期三尖瓣重度反流疗效分析[J]. 岭南现代临床外科, 2020, 20(03): 304-306.
[10]	何旭辉, 郑潮顺, 胡铮, 郭跃跃. MIS-TLIF与PLIF治疗单节段退行性腰椎疾病短期疗效对比[J]. 岭南现代临床外科, 2020, 20(02): 188-192.
[11]	徐燕. 巨大子宫肌瘤的腹腔镜手术体会和经验[J]. 岭南现代临床外科, 2020, 20(01): 89-92.
[12]	赵勇，许圣犬，徐修磊. 关节镜辅助下后外侧胫骨平台骨折内固定治疗的疗效分析[J]. 岭南现代临床外科, 2019, 19(06): 736-741.
[13]	陈帅，张小海，张宏艺，区永亮. 关节镜辅助下微创内固定治疗Schatzker Ⅰ-Ⅳ型胫骨平台骨折[J]. 岭南现代临床外科, 2019, 19(05): 596-599.
[14]	戴康夫1，2，黄志锋2，张延强3，张士节2，张龙2，欧希2，林泽伟2，尹耀新2，刘吉奎2，刘晓平1，2*. 开腹肝切除术与腹腔镜肝切除术治疗肝脏疾病的短期疗效及费用对比分析[J]. 岭南现代临床外科, 2019, 19(03): 251-255.
[15]	黎亨1，李志忠2*. 显微镜下MIS?TLIF与PLIF治疗单节段Wiltse IV型腰椎滑脱症的临床疗效比较[J]. 岭南现代临床外科, 2019, 19(01): 67-70.