基于CT断层扫描的手术入路策略在复杂胫骨Pilon骨折切开复位内固定中的应用

发布时间：2017-12-31 00:27

本文关键词：基于CT断层扫描的手术入路策略在复杂胫骨Pilon骨折切开复位内固定中的应用　出处：《中华骨与关节外科杂志》2016年05期 　论文类型：期刊论文

【摘要】：背景:高能量损伤导致的复杂胫骨Pilon骨折常伴有较严重的软组织损伤,手术并发症发生率较高,而手术入路的合理选择直接关系到治疗的成败。目的的:探讨基于CT断层扫描的手术入路策略在复杂胫骨Pilon骨折切开复位内固定中的应用及临床疗效。方法法:回顾性分析2011年10月至2014年3月收治的29例复杂闭合性胫骨Pilon骨折,男21例,女8例,年龄24~65岁,平均(44.5±7.1)岁。依据AO/OTA分型,其中43C2型11例,43C3型18例,基于CT断层扫描的骨折线分布和骨块移位情况选择相应的手术入路,采用切开复位,组合接骨板内固定进行治疗。术后应用Burwell-Charnley放射学评价标准判定骨折复位质量,依据美国矫形足踝协会(AOFAS)踝与后足评分标准进行功能评价,记录相关并发症、骨折愈合时间及末次随访AOFAS评分。结果果:27例获得随访,随访时间12~36个月,平均(21.4±6.3)个月,关节面获得解剖复位19例,复位较好5例,复位一般3例。骨折均于术后3~6个月愈合,平均愈合时间为(4.8±1.9)个月。末次随访未见骨折畸形愈合及内固定失败;末次随访时AOFAS评分67~95分,平均(85.4±6.5)分,其中优9例,良13例,可5例,差0例,优良率达81.5%。结论论:在复杂胫骨Pilon骨折切开复位内固定术中应用基于CT断层扫描的的手术入路策略,可精准重建关节面,组合接骨板内固定牢靠,术后早期功能锻炼,有利于患肢功能恢复,相关并发症较少。
[Abstract]:Background: complex tibial Pilon fractures caused by high energy injury are often accompanied with severe soft tissue injuries and the incidence of surgical complications is high. The reasonable choice of surgical approach is directly related to the success or failure of the treatment. To investigate the application and clinical effect of surgical approach based on CT tomography in open reduction and internal fixation of complex Pilon fracture of tibia. From October 2011 to March 2014, 29 cases of complex closed tibial Pilon fractures were retrospectively analyzed. There were 21 males and 8 females, aged 24 to 65 years, with an average age of 44.5 卤7.1 years. According to AO/OTA classification, 11 cases of 43 C2 type were classified as 43 C 3 type 18 cases. Based on the distribution of fracture line and the displacement of bone mass, the operative approach was selected and the open reduction was adopted. Burwell-Charnley radiologic evaluation criteria were used to evaluate the quality of fracture reduction. The functional evaluation was performed according to the AOFAS-based ankle and hind foot scoring criteria of the American Orthopaedic ankle Association, and related complications were recorded. Results 27 cases were followed up for 12 ~ 36 months (mean 21.4 卤6.3) months. Anatomical reduction was obtained in 19 cases, good reduction in 5 cases, and general reduction in 3 cases. Fractures healed 3 ~ 6 months after operation. The average healing time was 4.8 卤1.9 months. At the last follow-up, AOFAS score ranged from 67 to 95, with an average score of 85.4 卤6.5, of which 9 were excellent, 13 were good, 5 were fair, and 0 were poor. Conclusion: in the open reduction and internal fixation of complex Pilon fracture of tibia, the operative approach based on CT scanning can accurately reconstruct the articular surface. Combined plate fixation and early functional exercise were beneficial to the recovery of limb function, and the related complications were less.
【作者单位】：广州军区武汉总医院骨科;
【分类号】：R687.3
【正文快照】： 胫骨Pilon骨折并不常见,只占胫骨骨折的5%~7%,其中约30%是高能量损伤导致的复杂Pilon骨折(AO/OTA43C型),此类型骨折常常伴有较严重的软组织损伤,致残和致畸率较高,治疗起来极具挑战[1]。AO/ASIF最早提出了胫骨Pilon骨折的经典治疗原则:1腓骨解剖重建,2胫骨远端关节面解剖重建,

【参考文献】