[1]陈王 余添赐 李铭雄.骨盆漂浮体位后外联合后内侧入路治疗后Pilon骨折24例[J].中国中医骨伤科杂志,2021,29(01):76-79.
　CHEN Wang YU Tianci LI Mingxiong.24 Cases of Posterior Pilon Fracture Treated by Posterolateral andPosteromedial Approach with Pelvic Floating Position[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2021,29(01):76-79.
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骨盆漂浮体位后外联合后内侧入路治疗后Pilon骨折24例()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第29卷
期数:
2021年01期
页码:
76-79
栏目:
临床报道
出版日期:
2021-01-15

文章信息/Info

Title:
24 Cases of Posterior Pilon Fracture Treated by Posterolateral andPosteromedial Approach with Pelvic Floating Position
文章编号:
1005-0205(2021)01-0076-04
作者:
陈王1 余添赐1 李铭雄1
Author(s):
CHEN Wang1 YU Tianci1 LI Mingxiong1
1Department of Lower Limbs, Quanzhou Orthopedic-Traumatological Hospital, Quanzhou 362000, Fujian China.
关键词:
漂浮体位;  手术入路;  后Pilon骨折
Keywords:
floating position;  surgical approach;  posterior Pilon fracture
分类号:
R683.42
文献标志码:
B
摘要:
目的:评估在骨盆漂浮体位下通过踝关节后外联合后内侧入路治疗后Pilon骨折的临床疗效。方法:选取2016年6月至2019年6月收治的后 Pilon 骨折患者24例,采用骨盆漂浮体位从踝关节后外联合后内侧入路进行钢板螺钉内固定治疗。观察和记录手术时间、术中出血量、术后切口并发症、骨折临床愈合时间及末次随访美国足踝外科协会(AOFAS)踝与后足功能评分。结果:24例患者均得到随访,随访时间9～18个月,平均13.3个月; 手术时间70～120 min,平均95 min; 术中出血量20～150 mL,平均60 mL; 术后切口均未发生感染、皮缘坏死,均为一期愈合; 骨折临床愈合时间10～20周,平均14周; 末次随访AOFAS踝与后足评分优16例,良5例,中3例,差0例。结论:后Pilon骨折手术治疗时采用骨盆漂浮体位,通过踝关节后外联合后内侧入路手术暴露清晰,骨折复位和钢板螺钉放置简便,固定牢固,临床疗效满意。
Abstract:
To evaluate the clinical effect of pelvic floating position via posterolateral and posteromedial approach in treating posterior Pilon fracture treated. Methods: 24 patients with posterior Pilon fracture admitted from June 2016 to June 2019 were selected and treated with plate and screw internal fixation through posterolateral and posteromedial approach of ankle joint by pelvic floating position. The operation time, intraoperative blood loss, postoperative incision complications, clinical fracture healing time and the American Orthopaedic Foot Ankle Society(AOFAS)ankle-hindfoot score at the last follow-up were observed and recorded. Results: All the 24 patients were followed up for 9-18 months(13.3 months on average). The operation time was 70-120 min(95 min on average). Intraoperative blood loss was 20-150 mL(60 mL on average). No infection or wound edge necrosis occurred in all the incisions, and all the cases had primary healing. The clinical fracture healing time was 10-20 weeks(14 weeks on average). AOFAS ankle and hindfoot scores at the last follow-up showed that 16 cases were excellent, 5 cases were good, 3 cases were medium, and 0 cases were poor. Conclusion: Posterior Pilon fracture treated with pelvic floating position through the posterolateral and posteromedial approach can achieve satisfactory clinical effect, which is well for operation exposure as well as fracture reduction, and get the internal fixation placement simple and firm.

参考文献/References:

[1] HANSEN S T.Functional reconstruction of the foot and ankle[M].Philadelphia:Lippincott Williams & Wilkins,2000:37-46.
[2] 魏世隽,蔡贤华,刘曦明,等.后内侧入路低切迹多向锁定接骨板内固定治疗累及内踝的胫骨后Pilon骨折[J].中国修复重建外科杂志,2014,28(5):558-561.
[3] 赵宏谋,梁晓军,李毅,等.胫骨远端内外翻畸形对胫距关节接触的影响[J].中国修复重建外科杂志,2016,30(7):826-829.
[4] KLAMMER G,KADAKIA A R,JOOS D A,et al.Posterior Pilon fractures:a retrosp ective case series and proposed classification systern[J].Foot Ankle Int,2013,34(2):189-199.
[5] KITAOKA H B,ALEXANDER I J,ADELAAR R S,et al.Clinical rating systems for the ankle-hindfoot,midfoot,hallux,and lesser toes[J].Foot Ankle Int,1994,15(7):349-353.
[6] WANG L,SHI Z M,ZHANG C Q,et al.Trimalleolar fracture with involvement of the entire posterior plafond[J].Foot Ankle Int,2011,32(8):774-781.
[7] AMOROSA L F,BROWN G D,GREISBERG J.A surgical approach to posterior Pilon fractures[J].Journal of Orthopaedic Trauma,2010,24(3):188-193.
[8] SWITAJ P J,WEATHERFORD B,FUCHS D,et al.Evaluation of posterior malleolar fractures and the posterior Pilon variant in operatively treated ankle fractures[J].Foot Ankle Int,2014,35(9):886-895.
[9] 方玮,杨文贵,韩雪昆,等.漂浮体位下后外侧、后内侧双切口入路手术治疗KlammerⅡ、Ⅲ型后Pilon骨折[J].中国骨与关节损伤杂志,2019,34(4):410-412.
[10] 张述才,翟得平,马创,等.后外侧或联合后内侧入路支撑钢板内固定治疗后Pilon骨折[J].中国骨与关节损伤杂志,2017,32(6):655-656.
[11] HOWARD J L,AGEL J,BAREI D P,et al.A prospective study evaluating incision placement and wound healing for tibial plafond fractures[J].Journal of Orthopaedic Trauma,2008,22(5):299-306.
[12] THORDARSON D B.Complications after treatment of tibial Pilon fractures:prevention and management strategies[J].Journal of the American Academy of Orthopaedic Surgeons,2000,8(4):253-265.
[13] 宋哲,张堃.胫骨Pilon骨折手术治疗并发症的防治进展[J].中华创伤杂志,2014,30(7):658-661.
[14] 东靖明,田旭,马宝通.经踝关节后外侧入路治疗三踝骨折[J].中华创伤杂志,2013,29(6):536-540.
[15] 王正,程建,冯欢欢.后路内外侧联合入路治疗后Pilon骨折[J].骨科,2017,8(5):407-409.
[16] GONZALEZ T A,WATKINS C,DRUMMOND R,et al.Transfibular approach to posterior malleolus fracture fixation:technique tip[J].Foot Ankle Int,2015,37(4):440-445.
[17] 罗伟东,黄枫,郑晓辉,等.经后外侧入路内固定治疗后Pilon骨折的疗效分析[J].中国中医骨伤科杂志,2016,24(2):64-66.

备注/Memo

备注/Memo:
1福建省泉州市正骨医院下肢二科(福建 泉州,362000)
更新日期/Last Update: 2021-01-15