锁定加压钢板置入修复Pilon骨折:6个月随访骨折愈合及踝关节功能评价

Locking compression plate for Pilon fracture:fracture healing and ankle function during 6-month follow-up

背景:Pilon骨折的修复方法较多,但效果往往不理想。伴随着科学技术的发展,骨折固定原则的根本性转变以及技术和观念的革新,给Pilon骨折修复带来了新的契机。其中生物学固定技术可尽量减少进一步破坏骨折端骨外膜血供,不扰乱骨折愈合的生物力学环境,是目前研究发展的新趋势。目的:探讨采用生物学固定技术锁定加压钢板置入内固定修复Pilon骨折的效果。方法:回顾性分析2008年6月至2013年12月佛山市南海区经济开发区人民医院官窑分院收治应用锁定加压钢板置入内固定修复Pilon骨折76例患者的临床资料,男49例,女27例;年龄19-60岁,平均39.5岁;骨折根据Ruedi-Allgower分型:Ⅱ型54例,Ⅲ型22例。根据生物学固定技术采用锁定加压钢板置入内固定修复Pilon骨折。治疗后定期随访,根据Burwell-Charnley放射学复位标准评定复位质量,复查X射线片观察骨折愈合情况,末次随访时按Baird-Jackson评分标准评定踝关节功能。结果与结论:76例患者获6-24个月随访。根据Burwell-Charnley放射学复位标准评定复位质量:解剖复位68例,复位可8例。切口一期愈合71例,切口渗液换药后愈合5例,切口一期愈合率达93%。所有患者骨折均愈合,愈合时间4-8.5个月,平均6.25个月。末次随访时踝关节功能按Baird-Jackson评分标准评定:优69例,良5例,可2例。提示采用锁定加压钢板置入内固定修复Pilon骨折具有良好的稳定性,可有效避免破坏骨折端血供,缩短骨折愈合时间,操作简便,对软组织损伤小,是修复Pilon骨折的有效内固定方法之一。

BACKGROUND：There are many methods that can repair Pilon fracture, but the effects are not ideal. With the development of science and technology, fundamental change of fracture fixation principle and innovation of technology and idea has brought new opportunities for Pilon fracture repair. Biological immobilization technology can further reduce the further damage to blood supply of bone outer membrane on the fracture end, do not disturb biomechanical environment of fracture healing, and is the new trend of present research and development. OBJECTIVE：To investigate the effect of locking compression plate fixation for repair of Pilon fracture using biological fixation technique. METHODS：Clinical data of 76 patients with Pilon fracture treated using locking compression plate fixation in the Nanhai District Economic Development Zone Guanyao Branch of the People’s Hospital from June 2008 to December 2013 were retrospectively analyzed. There were 49 males and 27 females, at the age of 39.5 years on average （range from 19 to 60 years）. According to Ruedi-Algower classification, there were 54 cases of type II and 22 cases of type III. In accordance with biological fixation technique, locking compression plate fixation wasnbsp;applied to treat Pilon fracture. Folowing treatment, they were regularly folowed up. Reduction quality was assessed by Burwel-Charnley radiological criteria. X-ray films were reviewed to observe fracture healing. During final folow-up, ankle function was evaluated according to Baird-Jackson score. RESULTS AND CONCLUSION：A total of 76 patients were folowed up for 6 to 24 months. Reduction quality assessed by Burwel-Charnley radiological criteria was as folows： anatomic reduction of 68 cases, reduction of 8 cases, 71 cases of one-stage wound healing, and 5 cases of wound healing after dressing change, with the rate of one-stage healing of 93%. Fractures of al patients were healed. The healing time was 4 to 8.5 months, averagely 6.25 months. During final folow-up, ankle function assessed by Baird-Jackson score was as folows： there were 69 excelent cases, 5 good cases and 2 average cases. These results indicate that locking compression plate fixation for Pilon fracture obtained good stability, could effectively avoid the damage of fracture end blood supply, shorten the healing time; it was simple to operate, had smal injury to soft tissue, and was an effective fixation method to repair Pilon fracture.