摘要
目的观察分期手术治疗开放性Pilon骨折的临床疗效。方法回顾性分析自2013-01—2016-06诊治的27例开放性Pilon骨折,一期清创后采用外固定架固定或行跟骨牵引术,二期行切开复位钢板螺钉内固定。末次随访时采用Olerud-Molander评分标准评定踝关节功能。结果27例均获得随访,随访时间平均18(11~37)个月。3例伤口发生皮缘坏死,换药后伤口延迟愈合;1例GustiloⅢB型伤口边缘出现部分皮肤坏死,切除坏死皮肤,创面新鲜后游离植皮;4例出现创面浅表感染,全身应用抗生素治疗及局部换药后感染得到有效控制,创面愈合。骨折均在术后4~7个月骨性愈合。末次随访时Olerud-Molander评分平均92(75~100)分。2例踝关节功能评分为75分,1例术后12个月X线片显示踝关节有骨关节炎表现,1例术后X线片显示踝关节骨性融合。结论对于开放性Pilon骨折,一期彻底清创外固定架固定或行跟骨牵引术可降低感染风险,为软组织修复提供相对稳定的力学环境;二期内固定在软组织条件相对安全下进行,踝关节面骨折解剖复位,骨折坚强内固定有利于踝关节早期功能锻炼。
Objective To observe the clinical effect of staged surgical treatment for open Pilon fractures.Methods Twenty-seven cases of open Pilon fractures were analyzed retrospectively from January 2013 to June 2016.External fixator or calcaneal traction was used after primary debridement,second-stage open reduction,plate and screw internal fixation were performed.At the last follow-up,Olerud-Molander score was used to evaluate the ankle function.Results All 27 patients were followed up for an average of 18(11-37)months.Skin necrosis occurred in 3 cases and healed after dressing change.Partial skin necrosis occurred in 1 case of Gustilo type 111 B wound,necrotic skin was excised and free skin grafting was performed after fresh wound.Superficial wound infection occurred in 4 cases,infection was effectively controlled after systemic antibiotic treatment and local dressing change,and wound healing was achieved.All fractures healed at 4-7 months postoperatively.The mean Olerud-Molander score was 92(75-100)at the last follow-up.The ankle function score was 75 in 2 cases,1 case showed osteoarthritis on X-ray film 12 months after operation,and 1 case showed ankle bone fusion on X-ray film after operation.Conclusion For open Pilon fractures,one-stage debridement with external fixator or calcaneal traction can reduce the risk of infection and provide a relatively stable mechanical environment for soft tissue repair;second-stage internal fixation is performed under relatively safer soft tissue conditions.Anatomical reduction of the ankle and strong internal fixation are conducive to early functional exercise of the ankle.
作者
朱燕辉
王祥
胡小鹏
赵杰
金晨
ZHU Yan-hui;WANG Xiang;HU Xiao-peng;ZHAO Jie;JIN Chen(Department of Orthopaedic Surgery,Shanghai Ninth People's Hospital,Shanghai Jiootong University School of Medicine,Shanghai Key Laboratory of Orthopaedic Implants,Shanghai 201999,China)
出处
《中国骨与关节损伤杂志》
2018年第10期1043-1045,共3页
Chinese Journal of Bone and Joint Injury
