摘要
目的探讨影响切开复位内固定治疗Pilon骨折疗效的相关因素。方法2005年4月至2011年5月，采用切开复位钢板内固定治疗Pilon骨折52例。根据Ruedi．Allgower分型：Ⅰ型13例，Ⅱ型22例，Ⅲ型17例。受伤至手术时间6h-37d，平均11．1d。骨折复位影像学评估采用Burwell—Charnley标准，术后踝关节功能根据美国骨科足踝外科协会（AOFAS）踝关节功能评分系统进行评价。对骨折类型、复位质量、并发症等与疗效关系进行分析，评估影响疗效的因素。结果52例平均随访14．1个月（6～28个月）。骨折全部愈合，愈合时间4．0～11个月，平均5．5个月。胫骨远端关节面：解剖复位20例，一般24例，差8例。踝关节功能：优12例，良26例，可9例，差5例。并发症发生率30．8％（16例），包括切口皮肤坏死5例，浅表感染4例，深部感染1例，创伤性关节炎6例。Ⅰ型骨折复位质量与Ⅱ、Ⅲ型之间差异有统计学意义（r=11．33，P=0．003）。Ⅰ、Ⅱ型骨折术后优良率与Ⅲ型之间差异有统计学意义（Y。=5．205，P=0．0：23），而Ⅰ型与Ⅱ型之间差异无统计学意义（x2=1．300，P=0．254）。骨折复位质量与疗效存在等级正相关（r=0．513，P〈0．01）。并发症皮肤坏死、浅表感染和深部感染的发生在功能为优良组和可差组之间差异无统计学意义（P〉0．05），而创伤性关节炎在功能为可差组的发生明显较优良组高，二者具有统计学差异（P=0．005）。结论Pilon骨折的临床疗效受骨折类型、复位质量和创伤性关节炎等因素影响。
Objective To explore the relevant influencing factors of surgical outcomes for closed tibial pilon fractures. Methods From April 2005 to May 2011, 52 consecutive closed tibial pilon fractures were treated by the same surgical team. There were 35 males and 17 females with a mean age of 40. 0 years. According to the Ruedi-Allgower classification, the fracture types included type I （n = 13）, type 11 （n =22） and type Ⅲ （n = 17）. All patients were evaluated by the scores of American Orthopedic Foot and Ankle Society （AOFAS） and Burwell-Chamley. Postoperative complications were also recorded. The primary influencing factors of clinical outcomes were determined with regards to fracture types, reduction, complications and outcomes. Results The average follow-up period was 14. 1 months （range：6 -28 ）. The mean healing time was 5.5 months （ range ：4. 0 - 11 ）. The reduction status ： anatomical （ n = 20 ） , functional （ n = 24 ） and poor （ n = 8 ）. Ankle function was excellent （ n = 12） , good （ n = 26 ） , fair （ n = 9 ） and poor （ n = 5 ） . Incidence of complication was 30. 8% （ n = 16 ） , including incision skin necrosis （ n = 5 ） , superficial soft tissue infection （ n = 4 ）, deep infection （ n = 1 ） and posttraumatic arthrosis （ n = 6 ）. No significant differences （ P 〉 0. 05 ） existed in the occurrence of incision skin necrosis, superficial infection and deep infection between the outcomes of excellent/good and fair/poor groups while posttraumatic arthrosis rate had significant difference （ P = 0. 005 ） between two groups. The quality of reduction was an independent risk factor of final clinical outcomes. Conclusion The quality of reduction, types of fracture and occurrence of posttraumatic arthrosis are risk factors of final outcomes for closed tibial pilon fractures.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第27期1909-1912,共4页
National Medical Journal of China
关键词
胫骨骨折
内固定器
治疗效果
Tibia fractures
Internal fixators
Treatment outcome
