支撑钢板固定后侧pilon骨折的疗效分析

发表时间：2014-06-16 浏览次数：959次

引用：

俞光荣，陈大伟，赵宏谋等.支撑钢板固定后侧pilon骨折的疗效分析[J].中华创伤杂志.2013, 29(3):243-248.

关键词：

后侧pilon骨折,横断面CT扫描,支撑钢板治疗

作者：

俞光荣，陈大伟，赵宏谋，杨云峰，余霄，周家钤，李兵

作者单位：

同济大学附属同济医院骨科,上海,200065

出版年份：

2013

期刊页数：

243-248

收录者：

知网,万方

摘要：

目的回顾性评估支撑钢板治疗后侧pilon骨折的临床疗效. 方法 2005年1月-2009年12月,通过支撑钢板治疗16例后侧pilon骨折,其中男11例,女5例；平均年龄37.6岁(23～62岁).患者术前均行X线片、CT及三维重建检查.根据CT显示的骨折线累及范围选用后外侧入路或联合入路(后内侧加后外侧)复位固定后踝骨块.术后通过临床检查及X线片随访,临床评估采用美国足踝外科协会(AOFAS)踝-后足评分和视觉模拟评分(visual analogue scale,VAS). 结果根据术前CT扫描将后侧pilon骨折分为三型.14例患者获得随访,平均时间37.6个月(16～52个月),平均AOFAS评分为86.4分(70～98分),平均VAS评分为1.4分(0～3分).1例术后2年仍有踝周肿胀和长期行走不适,其余患者均功能恢复良好,未发现内固定失败. 结论支撑钢板治疗后侧pilon骨折临床疗效肯定,患者可以早期负重功能锻炼. Objective To retrospectively assess clinical outcomes of buttress plating in fixation of posterior pilon fractures.Methods The study involved 16 cases of posterior pilon fractures that had undergone buttress plate fixation between January 2005 and December 2009.There were 11 males and 5 females,at mean age of 37.6 years (range,23-62 years).All cases received radiography,CT scan and three-dimensional reconstruction preoperatively.Posterior malleolar fragments were reduced and fixed through posterolateral approach or combined approach (posteromedial plus posterolateral approaches) based on effect area of fracture line on CT films.Clinical and radiographic examinations were performed in postoperative follow-up.Clinical outcomes were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS).Results Posterior pilon fractures were classified into 3 types according to CT scans.Fourteen cases were followed up for average 37.6 months (range,16-52 months).Mean AOFAS score was 86.4 points (range,70-98 points) and mean VAS score was 1.4 points (range,0-3 points).All cases received favorable functional outcomes without hardware failure,except that one patient still suffered from peri-ankle swelling and long term walking discomfort two years after operation.Conclusion Buttress plating is effective in treatment of posterior pilon fractures and can facilitate early weight-bearing functional exercise.

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