外侧单一切口治疗Pilon骨折28例疗效分析

Clinical analysis of Pilon fractures treated through a single lateral approach for 28 patients

目的:探讨采用外侧单一切口切开复位内固定治疗Pilon骨折的临床疗效。方法:2016年1月至2017年5月采用外侧单一切口切开复位内固定治疗28例Pilon骨折患者,其中男17例,女11例;年龄25~59(39.2±12.2)岁;左侧13例,右侧15例;根据Rüedi-Allg?wer分型,Ⅰ型7例,Ⅱ型11例,Ⅲ型10例。所有患者急诊24 h内行骨折外固定支架术或者跟骨牵引术,待软组织条件允许后再行切开复位内固定术。记录患者切口愈合、骨折愈合及并发症情况,并于术后1年采用美国足踝外科协会(AOFAS)足踝评分系统对踝关节功能进行评价。结果:28例患者均获得随访,时间12~25(16.4±7.2)个月。2例患者出现手术切口的浅部感染,伤口延迟愈合;1例患者发生部分皮肤的坏死,经伤口换药护理后伤口愈合。28例患者切口愈合时间11~25(15.2±8.4) d。所有患者获得骨折愈合,时间12~18(15.2±3.4)周。2例患者术后行走出现踝关节疼痛,X线片显示发生了创伤性骨关节炎,予以服用非甾体消炎药后缓解。无深部感染、骨不连、骨折延迟愈合、骨折畸形愈合、内固定松动等并发症。术后1年AOFAS评分为(89.6±5.7)分,其中优14例,良12例,可2例。结论:外侧单一切口治疗Pilon骨折可以很好地暴露,复位和固定关节面骨折块,同时软组织并发症少,临床疗效满意,但是对于内翻型Pilon骨折或者胫骨内侧粉碎性骨折,由于外侧切口难以在胫骨内侧放置主力钢板,选用前内侧切口或广泛前侧切口更合适。

Objective:To explore clinical effect of open reduction and internal fixation through a single lateral approach for Pilon fractures.Methods:From January 2016 to May 2017,28 patients with Pilon fractures were treated with open reduction and internal fixation through a single lateral approach.Among them,including 17 males and 11 females,aged from 25 to59 years old with an average of(39.2±12.2) years old;13 patients on the left side and 15 patients on the right side;according to Ruedi-Allgower classificaton,7 patients were type Ⅰ,11 patients were type Ⅱ,10 patients were type Ⅲ.All patients were performed external fixation or calcaneal traction within 24 h of emergency,and open reduction and internal fixation was performed after swelling of soft tissue.Healing of incision and fracture,postoperative complications were observed,and AOFAS score at 1 year after operation was used to evaluate ankle joint function.Results:Twenty-eight patients were followed up from 12 to 25 months with an average of(16.4±7.2) months.Two patients occunred superficial wound infection caused delayed wound healing,1 patient occurred partial skin necrosis and healed after wound dressing change.The healing time of incision ranged from11 to 25 days with an average of(15.2±8.4) days.All patients got bone union and the time ranged from 12 to 18 weeks with an average of(15.2±3.4) weeks.Two patients suffered from ankle pain after walking postoperatively and X-ray showed traumatic arthritis,the pain got better with the treatment of non steroidal anti inflammatory drugs.No cases of deep infection,nonunion,delayed union,malunion,loosening of internal fixation occurred after operation.AOFAS score at 1 year after operation was89.6±5.7,14 patients got excellent results,12 good,and 2 fair.Conclusion:The single lateral approach for surgical treatment of Pilon fractures could provide sufficient exposure,reduction and fixation with less soft tissue application and the clinical curative effect is satisfied.However,for Pilon fracture with varus deformity or comminuted fracture on the medial side of tibial,it is difficult to place the main plate on the medial side of tibial.Instead,anteromedial incision or extensive anterior incision is more suitable.