自体髂骨移植重建胫骨pilon骨折胫骨远端关节面缺损的临床疗效

Rconstruction of defected articular surface of distal tibia with autogenous ilia bone grafting in pilon fractures

目的探讨自体髂骨移植重建胫骨pilon骨折胫骨远端关节面缺损的疗效。方法2007年3月至2010年7月共收治19例22侧胫骨pilon骨折患者．男15例18侧，女4例4侧；年龄19～65岁，平均39．5岁。骨折根据Ruedi．Allgower分型均为Ⅲ型。5例存在开放伤口（均为Gusti—lo—AndersonI型）。本组患者胫骨远端关节丽缺损大小为1．0cm×1．0cm～3．0cm×2．5cm。所有患者均采用切外复位内固定联合自体髂骨移植重建胫骨pilon骨折胫骨远端关节而缺损。结果16例（18侧）患者术后获9～38个月（平均22个月）随访。移植髂骨重建胫骨远端关节面骨块全部成活，愈合时间为ld．16周（平均15．4周）。X线片示内固定物未进入关节腔。根据Teeny和Wiss提出的胫骨pilon骨折术后放射学评价标准评定骨折复位情况：关节面解剖复位率为77．8％（14／18）。骨折愈合率为94．4％（17／18）。根据Mazur等制定的踝关节症状与功能评分系统评定疗效：优5侧，良7侧，可5侧，差1侧，优良率为66．7％。结论对于胫骨pilon骨折胫骨远端部分关节面缺损，只要严格掌握手术适应证，精细操作，应片J自体髂骨修复重建缺损关节面是可取的，值得临床推广应用。

Objective To investigate the effect of autogenous lilac bone grafting for reconstruction of defected articular surface of distal tibia in pilon fractures. Methods From March 2007 to July 2010, we treated 19 patients with 22 tibial pilon fractures. They were 15 men （18 fractures） and 4 women （4 fractures）, aged from 19 to 65 years （average, 39.5 years）. They were all type III by Ruedi-Allgower classification. Five patients had open wnunds （type I by Gustilo-Anderson classification）. The defects at the articular surface of distal tibia ranged from 1.0 cm×1. O cm to 3.0 cm×2.5 cm in area. All the defects at the articular surface of distal tibia were reconstructed with open reduction and internal fixation plus autogenous iliae bone grafts. Results Sixteen patients （18 fractures） were followed up for 9 to 38 months, with an average of 22 months. All the autogenous iliae bone grafts healed after 14 to 16 weeks （average, 15.4 weeks）. X-ray examinations revealed no intruding of internal implants into the articular cavity. According to the Teeny＇s radiologieal evaluation system, anatomical reduction uf the related articular surface was found in 77.8% （14/18） of the fl＇aetures and primary healing in 94.4% （17/18）. According to the Mazur＇s criteria, 5 fracture were excellent, 7 good, 5 fair, and one poor, with a goud-to-excellent rate of 66.7%. Conclusion As long as the operation indications are strictly followed and operations are carefully conducted, autogenous lilac bone grafting is a good measure to reconstrnct the defected articular surface of distal tibia in pilon fractures and can be popularized in clinic.