| 有限固定结合外固定支架治疗Ⅲ型Pilon骨折的病例对照研究 |
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Received:April 18, 2013
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| 作者 | Author | 单位 | Unit | E-Mail |
| 段大鹏 |
DUAN Da-peng |
陕西省人民医院骨科, 陕西 西安 710068 |
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| 尤武林 |
YOU Wu-lin |
西安交通大学第二附属医院骨科, 陕西 西安 710004 |
Department of Orthopaedics, the Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China |
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| 姬乐 |
JI Le |
西安交通大学第二附属医院骨科, 陕西 西安 710004 |
Department of Orthopaedics, the Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China |
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| 张永涛 |
ZHANG Yong-tao |
西安交通大学第二附属医院骨科, 陕西 西安 710004 |
Department of Orthopaedics, the Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China |
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| 党晓谦 |
DANG Xiao-qian |
西安交通大学第二附属医院骨科, 陕西 西安 710004 |
Department of Orthopaedics, the Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China |
goodfriendduan@163.com |
| 王坤正 |
WANG Kun-zheng |
西安交通大学第二附属医院骨科, 陕西 西安 710004 |
Department of Orthopaedics, the Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China |
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| 期刊信息：《中国骨伤》2014年27卷，第1期，第29-33页 |
| DOI：10.3969/j.issn.1003-0034.2014.01.008 |
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目的：通过对33例Rüedi-Allgower Ⅲ型Pilon骨折的不同治疗方法进行疗效分析，探讨最佳治疗方案。
方法：对2009年10月至2012年1月对采用3种治疗方法（单纯石膏外固定术10例，胫骨远端解剖钢板内固定术11例及有限固定结合外固定支架12例）治疗的Ⅲ型Pilon骨折患者进行回顾性分析，对其治疗效果进行综合评定和分析。单纯石膏外固定组男5例，女5例；年龄24～61岁；受伤至治疗时间4 h～15 d;高处坠落伤3例，车祸伤4例，2例摔伤，其他伤1例。胫骨远端解剖钢板内固定组男7例，女4例；年龄21～64岁；受伤至治疗时间为3 h～12 d;高处坠落伤4例，车祸伤5例，摔伤1例，其他伤1例。有限固定结合外固定支架组男7例，女5例；年龄23～67岁；受伤至治疗时间5 h～11 d;高处坠落伤4例，车祸伤6例，摔伤1例，其他伤1例。主要观察和分析指标包括：①骨折复位的影像学表现，观察骨折对位对线情况及关节面是否平整等；②根据Bourne踝关节功能评定标准对最近一次随访的病例进行踝关节功能评分；③患者早期并发症（皮肤坏死、感染、骨折再移位及行走痛）和晚期并发症（骨折延迟愈合、畸形愈合、创伤性关节炎、关节僵硬及肌肉萎缩）的发生率。
结果：所有患者获随访，时间8个月～3年，有限固定结合外固定支架组及胫骨远端解剖钢板内固定组解剖复位分别为7例和8例，多于单纯石膏外固定组（2例）.术后随访踝关节功能评分：有限固定结合外固定支架组优8例，良3例，差1例；单纯石膏外固定组优3例，良4例，差3例；胫骨远端解剖钢板内固定组优5例，良4例，差2例；有限固定结合外固定支架治疗组疗效最佳。有限固定结合外固定支架组骨折早期并发症和晚期并发症的发生率低于其他两组。
结论：有限固定结合外固定支架治疗Ⅲ型Pilon骨折能较好地恢复踝关节功能，减少并发症的发生，可作为首选治疗方法。 |
| [关键词]:Pilon骨折 骨折固定术 石膏,外科 病例对照研究 |
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| Case-control study on effects of external fixation combined with limited internal fixation for the treatment of Pilon fractures of Rüedi-Allgower type Ⅲ |
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Abstract:
Objective: To analyze the effects of three surgical operations in the treatment of Pilon fracture of Rüedi-Allgower type Ⅲ,and put forward the best therapeutic method.
Methods: The clinical data of 33 patients with Pilon fracture who received surgical operations（plaster immobilization group,10 cases;distal tibia anatomical plate group,11 cases;external fixation with limited internal fixation group,12 cases） from October 2009 to January 2012 were analyzed. There were 5 males and 5 females,ranging in age from 24 to 61 years in the plaster immobilization group. There were 7 males and 4 females,ranging in age from 21 to 64 years in the distal tibia anatomical plate group. There were 7 males and 5 females,ranging in age from 23 to 67 years in the external fixation with limited internal fixation group. The Ankle X-ray of Pilon fracture after operation,ankle score,early and late complications were collected. Bourne system was used to evaluate ankle joint function.
Results: After 8 months to 3 years follow-up,it was found that three kinds of treatment had significant differences in the outcomes and complications（P<0.05）:the external fixation with limited internal fixation group got the best results. The number of anatomic reduction cases in the external fixation with limited internal fixation group（7 cases） and the distal tibia anatomical plate group（8 cases） was more than the plaster immobilization group（2 cases）. According to the ankle score,8 patients got an excellent result,3 good and 1 poor in the limited internal fixation group,which was better than those of distal tibia anatomical plate group（5 excellent,4 good and 2 poor） and the plaster immobilization group（3 excellent,4 good and 3 poor）. The number of early and late complications in the external fixation with limited internal fixation group was more than those in the plaster immobilization group and the distal tibia anatomical plate group（P<0.05）.
Conclusion: Treatment of external fixation with limited internal fixation in the treatment of Pilon fracture of Rüedi-Allgower type III is effective and safe. |
| KEYWORDS:Pilon fracture Fracture fixation Casts,surgical Case-control studies |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 段大鹏,尤武林,姬乐,张永涛,党晓谦,王坤正.有限固定结合外固定支架治疗Ⅲ型Pilon骨折的病例对照研究[J].中国骨伤,2014,27(1):29~33 |
| 英文格式: | DUAN Da-peng,YOU Wu-lin,JI Le,ZHANG Yong-tao,DANG Xiao-qian,WANG Kun-zheng.Case-control study on effects of external fixation combined with limited internal fixation for the treatment of Pilon fractures of Rüedi-Allgower type Ⅲ[J].zhongguo gu shang / China J Orthop Trauma ,2014,27(1):29~33 |
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