严重胫骨远端粉碎性骨折手术治疗远期评价.docVIP

严重胫骨远端粉碎性骨折手术治疗远期评价 　　[摘要] 目的 探讨胫骨远端粉碎性骨折（Pilons fracture）手术治疗的远期疗效。方法 对2000年1月～2009年7月在我院行手术治疗的311例Pilon骨折患者进行回顾性研究随访，其中268例获得规范随访。依据AO/OTA分型，美国骨科协会足踝外科分会（American orthopedic foot and ankle society，AOFAS）制订的踝关节功能评分标准和骨折复位情况影像学评估结果（Burwell-Charnley标准）进行分类，分别采用切开复位及胫骨远端有限接触性加压钢板内固定。 结果 268例患者的随访时间为2.0～10.5年，平均（7.86±1.56）年。AO/OTA分型为C2型者123例，C3型145例。AOFAS踝关节功能评分优126例，良104例，差38例，优良率为85.82%。Burwell-Charnley标准解剖复位181例，复位一般73例，复位差14例。 结论 重建小腿远端“两柱一体”的平衡与稳定是治疗Pilon骨折的关键，胫骨远端解剖型钢板是治疗胫骨下段骨折的理想内固定物，可使骨折断端良好复位，固定可靠。影响Pilon骨折疗效的因素，不仅是骨折的整复固定，更重要的是如何避免局部软组织的有关并发症。 　　[关键词] 胫骨骨折；治疗；手术；骨折固定术 　　[中图分类号] R683.42[文献标识码] A[文章编号] 1673-7210（2012）03（c）-0036-03 　　The long term follow-up and assessment on the treatment of serious Pilons fractures 　　ZHOU Yan ZHOU Junjie CHEN Xianqi PANG Jinhui GAO Wenwu 　　Department of Orthopedic, Putuo Hospital Affiliated to Shanghai Traditional Chinese Medical University, Shanghai 200062, China 　　[Abstract] Objective To study the long-term clinical effects of surgical treatment for Pilons factures. Methods From January 2000 to July 2009, 311 cases of Pilons fractures which underwent the surgery in our hospital were studied retrospectively. 268 patients who received standardized follow-up were classified according to AO/OTA, American orthopedic foot and ankle society (AOFAS) and Burwell-Charnley criteria. This group was treated with open reduction and used the lateral and medial limited contact compression plate to internal fixation. Results All of the 268 cases were classified as type C according to AO/OTA including 123 cases of C2 and 145 cases of C3. The follow-up of 2.0 to 10.5 years [(7.86±1.56) years in average] showed that there were 126 cases of excellent, 104 cases of fine and 38 cases of poor by AOFAS scale for ankle joint. The good and excellent rate was 85.82%. The outcome of reduction was evaluated by the Burwell-Charnley score. Anatomical reduction was found in 181 cases, function reduction was in 73 cases and poor reduction was 14 cases