多轴锁定钢板结合踝关节镜技术治疗高能量Pilon骨折的临床研究

发布时间：2019-04-02 14:26

【摘要】：目的:观察探讨多轴锁定钢板结合关节镜技术治疗高能量Pilon骨折的疗效。方法:自2010-02至2013-04,解放军100医院骨科手术治疗高能量Pilon骨折22例,术前严密设计,利用CT三维扫描重建骨折形态及关节面情况,术中采用关节镜技术辅助骨折复位及固定,利用多轴锁定钢板对胫骨远端粉碎性骨折进行固定,术后规范康复训练。通过分析手术时间、手术出血量及末次随访时踝关节的功能评分(Tornetta评价和Mazur评分)、影像学评价和术后并发症的发生情况评价多轴锁定钢板结合关节镜技术治疗高能量Pilon骨折的疗效。结果:22例均获得随访10~24个月,平均13.3个月。骨折均获得愈合,愈合时间7~19周,平均11.7周。其中1例出现皮肤坏死,行转移皮瓣修复,其余无深部感染、骨折不愈合、钢板外露等并发症发生。末次随访时均行踝关节CT检查,仅1例CT显示胫骨远端关节面欠平整,但暂无骨性关节炎表现;术后关节功能根据踝关节Tornetta评价:优16例,良4例,可2例,优良率90.91%;根据踝关节Mazur评分评定:优15例,良4例,可3例,优良率86.4%。结论:采用多轴锁定钢板结合关节镜技术治疗高能量Pilon骨折疗效值得肯定,有利于踝关节软组织的保护及关节面的解剖修复,有助于降低骨折早期及晚期的并发症发生率。对比其他术式,采用多轴锁定钢板结合关节镜技术治疗高能量Pilon骨折手术创伤更小、固定更可靠、内固定物的使用更少,是一种值得采用和推广的手术方式。
[Abstract]:Objective: to investigate the efficacy of multiaxial locking plate combined with arthroscopy in the treatment of high energy Pilon fracture. Methods: from 2010 / 02 to 2013 / 04, 22 cases of high energy Pilon fractures were treated surgically in the Department of Orthopaedics of PLA 100 Hospital. The fracture morphology and articular surface were reconstructed by CT 3D scanning. Arthroscopic technique was used to assist in reduction and fixation of fractures, multiaxial locking plate was used to fix distal tibial comminuted fractures, and postoperative rehabilitation training was standardized. The time of operation, the amount of bleeding during operation and the score of ankle function at the last follow-up were analyzed (Tornetta and Mazur). Evaluation of imaging and postoperative complications to evaluate the efficacy of multiaxial locking plate combined with arthroscopy in the treatment of high energy Pilon fractures. Results: all 22 cases were followed up for 10 months for 24 months (mean 13.3 months). All the fractures were healed, the healing time was 7-19 weeks (mean 11.7 weeks). One case had skin necrosis, and the other had no complications such as deep infection, nonunion of fracture and exposure of steel plate. At the last follow-up, CT was performed on ankle joint, only 1 case showed that the distal tibial joint face was not smooth, but there was no osteoarthritis at the moment, the postoperative joint function was evaluated according to the Tornetta of ankle joint: excellent in 16 cases, good in 4 cases, fair in 2 cases, excellent and good rate was 90.91%; According to the Mazur score of ankle joint, 15 cases were excellent, 4 cases were good, 3 cases were fair, the excellent and good rate was 86.4%. Conclusion: the treatment of high energy Pilon fracture with multiaxial locking plate combined with arthroscopy is worth affirming. It is beneficial to the protection of soft tissue of ankle joint and anatomical repair of articular surface. It is helpful to reduce the incidence of complications in early and late stage of fracture. Compared with other surgical methods, multiaxial locking plate combined with arthroscopy for the treatment of high-energy Pilon fracture surgery less trauma, more reliable fixation, less use of internal fixation, it is worth to adopt and promote the operation.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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