胫骨远端锁定钢板治疗AO/OTA C型闭合Pilon骨折的疗效

The effect of distal tibial locking plate for treatment of AO/OTA type C closed pilon fracture

目的探讨切开复位胫骨远端锁定钢板内固定治疗AO/OTA C型闭合Pilon骨折的疗效。方法对36例AO/OTA C型闭合Pilon骨折患者采用切开复位胫骨远端锁定钢板内固定治疗。结果 36例均获得随访,时间12～24(21. 3±3. 21)个月。患者骨折均愈合,时间为3～6(4. 2±1. 10)个月。取出内固定时间为术后12～16(13. 6±1. 32)个月。术后根据Burwell-Charnley影像学评价标准判定骨折复位情况:30例解剖复位,解剖复位率为83. 3%(30/36); 5例复位一般,1例复位差。末次随访时Teeny-Wiss踝关节功能评分为60～100(89. 19±5. 79)分,其中优12例,良19例,可4例,差1例,优良率为86. 1%(31/36)。结论胫骨远端锁定钢板治疗AO/OTA C型闭合Pilon骨折效果良好,充分的术前准备、熟悉胫腓骨远端及踝关节的解剖形态、术中精准的复位、内固定的技巧、时机的掌握是手术成功的关键。

Objective To evaluate the effect of open reduction and internal fixation with distal tibial locking plate for AO/OTA type C closed Pilon fractures. Methods The 36 patients with closed Pilon fractures were treated with open reduction and distal tibial locking plate. Results All cases were followed up for 12~24 (21.3±3.21) months. All 36 patients in this group were healed. The healing time was 3~6 (4.2±1.10) months. The time of removal of internal fixation was 12~16 (13.6±1.32) months. According to Burwell-Charnley imaging evaluation criteria, 30 cases were anatomic reduction,anatomic reduction rate of 83.3%(30/36);5 cases were general reduction, 1 case was poor reduction.At the last follow-up,Teeny-Wiss ankle function score was 60~100 (89.19±5.79) points, with excellent in 12 cases, good in 19, fair in 4 and poor in 1, the excellent-good rate was 86.1%(31/36). Conclusions The distal tibial locking plate has a good effect in the treatment of AO/OTA type C closed Pilon fracture. Adequate preoperative preparation, familiarity with the anatomical morphology of the distal tibiofibula and ankle joint, accurate intraoperative reduction, internal fixation techniques and timing are the keys to the success of the surgery.