摘要
背景:踝关节在所有人体关节中负重最大,所有的踝关节骨折均为关节内骨折,多为合并韧带损伤或者关节脱位的复杂损伤机制。其中后踝骨折占踝关节损伤的7%-44%,且当骨折累及后踝时,创伤性关节炎多发,其预后常常不能使人满意。后踝骨折的治疗对于恢复踝关节功能上具有重要意义,但目前对于后踝骨折的具体分型及治疗方案仍存在争议。目的:总结并讨论各种后踝骨分型以及对于各型后踝骨折的治疗方案。方法:由第一作者用计算机检索中国期刊全文数据库(CNKI:2000至2017年)和Medline(2000至2017年)数据库,检索词分别为"踝关节骨折、后踝骨折、胫骨远端骨折、Pilon骨折、分型、生物力学、诊断、治疗"和"malleolar fractures,posterior malleolar fractures,distal tibial fracture,Pilon fracture,classification,biomechanical,diagnosis,treatment",语言分别设定为中文和英文。从后踝的解剖、生物力学特性及后踝骨折的损伤机制、分型、治疗方法、手术入路,固定方式等方面进行总结,对后踝骨折的分型对临床治疗的指导等方面进行介绍。结果与结论:共检索到1 890篇文章,按纳入和排除标准对文献进行筛选,共纳入35篇文章。结果表明后踝骨折个体差异较大,且很少单独出现,经常伴随有内外踝或胫腓骨干的骨折,现阶段对于后踝骨折的分型错综复杂,各种分型指导临床治疗的意义众说纷纭,后踝骨折的治疗方式多种多样,且每一种治疗方式的不足均很突出。现阶段需要追寻一种新的分型方式,对后踝骨折进行系统、实用的分型,从而指导临床治疗。
BACKGROUND： Ankle joint is the largest heavy-load joint in human body. As an intra-articular fracture, the mechanism of injury is complicated which can occur with ligament injury and joint dislocation. The posterior malleolar fracture occurs in 7%-44% of the ankle fractures. The prognosis is usually unsatisfactory when the fracture involves the posterior malleolar because of traumatic arthritis. The treatment of posterior malleolus fracture is important for recovering ankle joint function, but the specific classification and treatment of the posterior ankle fracture are still controversial. OBJECTIVE： To summarize and discuss the classification and treatment options for posterior malleolus fractures.METHODS： First author searched literature from CNKI（2000/2017） and Medline database（2000/2017）. The key words were ＂malleolar fractures, posterior malleolar fractures, distal tibial fracture, Pilon fracture, classification, biomechanical, diagnosis, treatment＂ in Chinese and English. The guiding role for clinical treatment was introduced by summing up the anatomy and biomechanic characteristic of the ankle and damage mechanism, classification, treatment methods, surgical approach and fixed way of the posterior malleolar fractures. RESULTS AND CONCLUSION： Totally 1 890 papers were searched and 35 papers were chosen according to the inclusion and exclusion criteria. The results show that individuals with posterior malleolus fracture are significantly different and rarely appear alone, and often accompanied by internal or external malleolus fractures or tibial and fibular fractures. At present, the classification of posterior malleolus fracture is complicated and the significance of various types of guided clinical treatment is different. Also, the treatment of posterior malleolus fracture is varied and each type of treatment is not sufficient. At this stage, a new mode of parting is needed to guide the clinical treatment of the posterior malleolus fracture.
作者
张永铎
潘德悦
李学良
赵文志
Zhang Yong-duo;Pan De-yue;Li Xue-liang;Zhao Wen-zhi(Second Hospital of Dalian Medical University,Dalian 116023,Liaoning Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2018年第23期3744-3750,共7页
Chinese Journal of Tissue Engineering Research
