中国修复重建外科杂志

中国修复重建外科杂志

Ruedi-Allgower Ⅲ 型 Pilon 骨折中 Tillaux 骨块的处理

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目的探讨 Tillaux 骨块在 Ruedi-Allgower Ⅲ型 Pilon 骨折手术中的处理方法及效果。方法回顾分析 2010 年 2 月—2013 年 9 月收治的 21 例术前明确 Tillaux 骨块需要复位的 Ruedi-Allgower Ⅲ型 Pilon 骨折患者临床资料。其中男 17 例,女 4 例;年龄 28~68 岁,平均 42.9 岁。致伤原因:高处坠落伤 13 例,摔伤 4 例,撞伤 2 例,扭伤 2 例。入院行 X 线片和 CT 检查示,21 例合并腓骨远端骨折,均存在 Tillaux 骨块移位。按照 AO/OTA 分型:C1.2 型 3 例,C1.3 型 1 例,C2 型 10 例,C3 型 7 例。受伤至手术时间 4~31 d,平均 10 d。所有患者 Pilon 骨折接受切开复位钢板内固定治疗,针对 Tillaux 骨块选择合适的钢板或螺钉固定,针对压缩部分选择同种异体骨植骨处理。结果术后 2 例出现伤口拐角处皮肤坏死,经相应处理后愈合;余 19 例伤口Ⅰ期愈合。术后 72 h 内采用 Burwell-Chamley 影像学评分系统评价手术复位效果,其中解剖复位 19 例,一般复位 2 例。21 例均获随访,随访时间 18~48 个月,平均 24.9 个月。随访期间未发现神经损伤表现、内固定物松动移位及假体周围骨折等并发症。所有患者骨折均获骨性愈合,愈合时间 4~8 个月,平均 6 个月。19 例患者于术后 15~19 个月取出内固定。发生关节增生 17 例,骨性关节炎 4 例,患者均无关节活动度丧失。术后 1 年或末次随访时采用美国矫形足踝协会(AOFAS)踝与后足评分评价功能,获优 13 例、良 6 例、可 2 例,优良率 90.5%。根据 Olerud-Molander 踝关节骨折评分标准对踝关节功能恢复情况进行评价,术后全负重训练时获良 6 例、中 8 例、差 7 例,全负重训练 1 年时获优 10 例、良 3 例、中 6 例、差 2 例。结论对于复杂的 Ruedi-Allgower Ⅲ型 Pilon 骨折,Tillaux 骨块是一个比较可靠的复位标志,关节面重建以此为标志可提高手术疗效。

ObjectiveTo analyze the importance and effectiveness of Tillaux bone block in Ruedi-Allgower type Ⅲ of Pilon fracture surgery.MethodsTwenty-one patients with Pilon fractures with Tillaux dislocation were treated between February 2010 and September 2013. There were 17 males and 4 females, aged from 28 to 68 years with an average age of 42.9 years. The causes of injury included falling from height in 13 cases, falls injury in 4 cases, crush injury in 2 cases, and sprained injury in 2 cases. X-ray film and CT examination showed that all 21 patients had fibula fracture and Tillaux bone block had obvious displacement. According to AO/OTA classification, there were 3 cases of type C1.2, 1 case of type C1.3, 10 cases of type C2, and 7 cases of type C3. The duration from injury to operation ranged from 4 to 31 days, with an average of 10 days. All cases of Pilon fracture were treated with open reduction and plate internal fixation. Steel plate or screw was used to fixation for Tillaux block; allograft bone graft was selected for compression of fracture.ResultsThere were 2 cases of skin necrosis at the corner of wound after operation, and the wound healed after corresponding treatment; the wound healed at first intention in the other 19 cases. The effect of surgical reduction was evaluated by Burwell-Chamley imaging scoring system within 72 hours after operation, there were 19 cases of anatomical reduction and 2 cases of general reduction. All the 21 patients were followed up 18-48 months, with an average of 24.9 months. No complication such as nerve injury, loosening of internal fixation, or periprosthetic fracture was found during follow-up. All fractures obtained bone healing, which lasted from 4 to 8 months, with an average of 6 months. The ankle and hindfoot scores of the American Orthopaedic Foot and Ankle Society (AOFAS) were used to evaluate the ankle and hindfoot function at 1 year after operation or at last follow-up, the results were excellent in 13 cases, good in 6 cases, and fair in 2 cases, with an excellent and good rate of 90.5%. Internal fixator was removed from 19 patients at 15-19 months after operation. There were 17 cases of joint hyperplasia and 4 cases of osteoarthritis. All joint mobility was restored. The functional recovery of the ankle joint was evaluated according to the Olerud-Molander ankle fracture score standard, the results were good in 6 cases, fair in 8 cases, and poor in 7 cases at postoperative full weight training; and after 1 year of full weight training, the results were excellent in 10 cases, good in 3 cases, fair in 6 cases, and poor in 2 cases.ConclusionThe Tillaux bone block is a reliable marker for the reduction of complex Pilon fractures. The reconstruction of the Tillaux can improve the effectiveness of complex Pilon fractures.

关键词: Tillaux 骨块; Pilon 骨折; 复位; 内固定

Key words: Tillaux bone block; Pilon fracture; restoration; internal fixation

引用本文: 王磊, 刘欣, 吴志新, 李力更, 胡永成. Ruedi-Allgower Ⅲ 型 Pilon 骨折中 Tillaux 骨块的处理. 中国修复重建外科杂志, 2018, 32(10): 1308-1312. doi: 10.7507/1002-1892.201710068 复制

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