本文關(guān)鍵詞：基于CT斷層掃描的手術(shù)入路策略在復(fù)雜脛骨Pilon骨折切開(kāi)復(fù)位內(nèi)固定中的應(yīng)用　出處：《中華骨與關(guān)節(jié)外科雜志》2016年05期 　論文類(lèi)型：期刊論文

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【摘要】：背景:高能量損傷導(dǎo)致的復(fù)雜脛骨Pilon骨折常伴有較嚴(yán)重的軟組織損傷,手術(shù)并發(fā)癥發(fā)生率較高,而手術(shù)入路的合理選擇直接關(guān)系到治療的成敗。目的的:探討基于CT斷層掃描的手術(shù)入路策略在復(fù)雜脛骨Pilon骨折切開(kāi)復(fù)位內(nèi)固定中的應(yīng)用及臨床療效。方法法:回顧性分析2011年10月至2014年3月收治的29例復(fù)雜閉合性脛骨Pilon骨折,男21例,女8例,年齡24~65歲,平均(44.5±7.1)歲。依據(jù)AO/OTA分型,其中43C2型11例,43C3型18例,基于CT斷層掃描的骨折線分布和骨塊移位情況選擇相應(yīng)的手術(shù)入路,采用切開(kāi)復(fù)位,組合接骨板內(nèi)固定進(jìn)行治療。術(shù)后應(yīng)用Burwell-Charnley放射學(xué)評(píng)價(jià)標(biāo)準(zhǔn)判定骨折復(fù)位質(zhì)量,依據(jù)美國(guó)矯形足踝協(xié)會(huì)(AOFAS)踝與后足評(píng)分標(biāo)準(zhǔn)進(jìn)行功能評(píng)價(jià),記錄相關(guān)并發(fā)癥、骨折愈合時(shí)間及末次隨訪AOFAS評(píng)分。結(jié)果果:27例獲得隨訪,隨訪時(shí)間12~36個(gè)月,平均(21.4±6.3)個(gè)月,關(guān)節(jié)面獲得解剖復(fù)位19例,復(fù)位較好5例,復(fù)位一般3例。骨折均于術(shù)后3~6個(gè)月愈合,平均愈合時(shí)間為(4.8±1.9)個(gè)月。末次隨訪未見(jiàn)骨折畸形愈合及內(nèi)固定失敗;末次隨訪時(shí)AOFAS評(píng)分67~95分,平均(85.4±6.5)分,其中優(yōu)9例,良13例,可5例,差0例,優(yōu)良率達(dá)81.5%。結(jié)論論:在復(fù)雜脛骨Pilon骨折切開(kāi)復(fù)位內(nèi)固定術(shù)中應(yīng)用基于CT斷層掃描的的手術(shù)入路策略,可精準(zhǔn)重建關(guān)節(jié)面,組合接骨板內(nèi)固定牢靠,術(shù)后早期功能鍛煉,有利于患肢功能恢復(fù),相關(guān)并發(fā)癥較少。
[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 鹵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 鹵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 鹵1.9 months. At the last follow-up, AOFAS score ranged from 67 to 95, with an average score of 85.4 鹵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.
【作者單位】： 廣州軍區(qū)武漢總醫(yī)院骨科;
【分類(lèi)號(hào)】：R687.3
【正文快照】： 脛骨Pilon骨折并不常見(jiàn),只占脛骨骨折的5%~7%,其中約30%是高能量損傷導(dǎo)致的復(fù)雜Pilon骨折(AO/OTA43C型),此類(lèi)型骨折常常伴有較嚴(yán)重的軟組織損傷,致殘和致畸率較高,治療起來(lái)極具挑戰(zhàn)[1]。AO/ASIF最早提出了脛骨Pilon骨折的經(jīng)典治療原則:1腓骨解剖重建,2脛骨遠(yuǎn)端關(guān)節(jié)面解剖重建,

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