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后内侧入路低切迹多向锁定接骨板内固定治疗累及内踝的胫骨后Pilon骨折 被引量:24

EFFECTIVENESS OF VERY LOW PROFILE/VARIABLE ANGLE LOCKING PLATE INTERNAL FIXATION IN TREATMENT OF POSTERIOR Pilon FRACTURES EXTENDING TO MEDIAL MALLEOLUS BY POSTEROMEDIAL APPROACH
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摘要 目的探讨后内侧入路低切迹多向锁定接骨板(very low profile/variable angle locking plate,VLP)内固定治疗累及内踝的胫骨后Pilon骨折的疗效。 方法2011年12月-2012年8月,收治13例累及内踝的胫骨后Pilon骨折患者。男4例,女9例;年龄23~68岁,平均48.9岁。摔伤9例,交通事故伤4例。左踝6例,右踝7例。骨折根据北美创伤骨科学会(OTA)分型标准:43B1型6例,43B2型4例,43B3型3例。12例合并腓骨骨折,按Denis-Weber分型标准:B型11例,C型1例。受伤至手术时间7~14 d,平均11.4 d。采用后内侧入路切开复位并VLP内固定后踝骨折。 结果术后切口均Ⅰ期愈合。2例出现胫神经麻痹症状,口服弥可保后症状消失。12例获随访,随访时间12~18个月,平均14.5个月。术后依据Burwell-Charnley影像学评价标准判定骨折复位质量,关节面获解剖复位11例,一般复位1例;无内固定物进入关节内。骨折均于术后3~6个月愈合,平均3.7个月。随访期间无内固定物松动、断裂等并发症发生。末次随访时根据美国矫形足踝协会(AOFAS)踝与后足评分标准行踝关节功能评估,获优7例,良4例,可1例,优良率91.7%。 结论对于累及内踝的胫骨后Pilon骨折,采用后内侧入路可直视下复位踝关节面,VLP固定简便可靠,软组织并发症少,近期疗效满意。 Objective To evaluate the effectiveness of very low profile/variable angle locking plate (VLP) internal fixation for posterior Pilon fractures extending to the medial malleolus by posteromedial approach. Methods A retrospective analysis was made on the clinical data from 13 patients with posterior Pilon fractures extending to the medial malleolus between December 2011 and August 2012. There were 4 males and 9 females with an average age of 48.9 years (range, 23-68 years). Fractures were caused by falling in 9 cases and by traffic accident in 4 cases. The locations were the left ankle in 6 cases and the right ankle in 7 cases. According to the Orthopedic Trauma Association (OTA) classification, 6 cases were rated as type 43B1, 4 cases as type 43B2, and 3 cases as type 43B3. Twelve cases had fibular fractures, including 11 cases of Denis-Weber type B, 1 case of Denis-Weber type C. The interval of injury and operation was 7-14 days (mean, 11.4 days). Open reduction was performed and VLP internal fixation was used for posterior malleolar fracture by posteromedial approach. Results Primary healing of incision was obtained in all patients. Tibial nerve palsy was observed in 2 cases, and was cured after oral administration of mecobalamin. Twelve cases were followed up 12-18 months (mean, 14.5 months). According to the Burwell-Charnley’s radiological evaluation system, 11 cases achieved anatomical reduction, 1 case achieved fair reduction. The fracture union time was 3-6 months (mean, 3.7 months). No loosening or breakage of internal fixation occurred during follow-up. According to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, the results were excellent in 7 cases, good in 4, and fair in 1; the excellent and good rate was 91.7%. Conclusion VLP internal fixation for posterior Pilon fractures extending to the medial malleolus by posteromedial approach can achieve good short-term effectiveness. The high quality of reduction is acquired under direct vision with low rate of soft tissue complications.
出处 《中国修复重建外科杂志》 CAS CSCD 北大核心 2014年第5期558-561,共4页 Chinese Journal of Reparative and Reconstructive Surgery
关键词 胫骨后Pilon骨折 后内侧入路 低切迹多向锁定接骨板 内固定 Posterior Pilon fracture Posteromedial approach Very low profile/variable angle lockingplate Internal fixation
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