Pilon骨折粉碎骨软骨关节面手术修复策略研究

Surgical repair strategy of crush articular cartilage surface in Pilon fracture patients

目的探讨Pilon骨折关节骨软骨面严重粉碎性损伤的手术修复策略及对愈合、功能的影响。方法 2007年4月～2010年5月手术治疗Pilon骨折85例,选择踝关节前内、外侧或后内、外侧入路。粉碎严重的塌陷关节面(碎裂软骨下骨及未游离的关节软骨)直视下应用距骨关节面作为模具、细克氏针、拉力螺钉及可吸收螺丝钉(聚左旋乳酸可吸收骨固定系统)固定、阻挡、镶嵌挤压、软骨下骨下方植骨等方法修复,后再应用胫骨远端解剖型锁定接骨板重建、支撑固定。术后外固定限制踝部活动4～6周。结果 85例随访11～38个月,平均16.6个月,关节面骨折复位质量影像学采用Matta标准:解剖复位80例,不满意3例,差2例。采用Philips踝关节评分系统评分:优80例,良3例,差2例;优良率94.29%。结论通过改进复位策略及技巧提高关节面复位质量及保证良好血供的锁定接骨板固定,可完成粉碎严重的Pilon骨折关节面的重建,明显提高胫骨远端关节骨软骨面的愈合质量及踝关节功能恢复良好率。

Objective To discuss the surgical repair strategy of crush articular cartilage surface in Pilon fracture patients and to explore the strategy on healing and function. Methods There were 85 Pilon fractures cases treated by surgery from Apr. 2007 to May 2010（ male 52 cases,female 33 cases）. Age ranged from 20-71 years,averaging 36.2 years. The surgical approach was through ankle inner side and outside after or before the ankle joint. Talus articular surface was used as mould, micro-Kirschner wire, tension screw and absorbing screws were used to fix, block and squeeze. Then the distal tibial anatomical locking plate was applied for reconstruction and support fixation. Activities were limited in the ankle joint for four to six weeks after operation. Results Totally 85 cases were followed up for 11-38 months ,with an average of 16.6 months. The joint surface fracture reposition was evaluated by Matta imaging quality standard： anatomical reattachment in 80 cases, not satisfactory reposition in 3 cases, and poor in 2 cases. The Philips ankle joint evaluation system showed 80 cases of excellent,3 cases of good and 2 cases of poor;the excellent and good rate was 94.29%. Conclusion Improving repositioning strategies and skills, impro- ving surface quality and making locked plate fixation with good blood supply can ensure joint reconstruction of severe Pilon fractures, obviously improve the quality of distal tibial bone and the recovery rate of ankle joint function.