Pilon骨折的外科治疗(英文PPT加翻译).ppt
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1、lObjective:Todiscussthemethods,timingandclinicaloutcomesofsurgicaltreatmentforopenpilonfractures.lMethods:FromApril2003toJuly2008,28patientswithopenpilonfracturesweretreated.lAllhadtypeCfracturesaccordingtotheArbeitsgemeinschaftfrosteosynthesefragenAssociationfortheStudyofInternalFixation(AO/ASIF)cl
2、assification.lThreeoperativemethodswereapplied,themethodsbeingdeterminedbythetypesoffracture,softtissuedamageandtimeintervalafterinjury.ltrauma创伤lclassification分类;分级ldebridement清创术、扩创术lanatomicreduction解剖复位ltheArbeitsgemeinschaftfrosteosynthesefragen瑞士骨折内固定协会/AOlBurwell-Charnleyscore骨折复位放射学评价标准1965l
3、Orthopaedic骨科的;整形外科的lComplication并发症lsloughing蜕皮;脱落lpost-traumaticarthritisrats创伤后关节炎lThorough彻底地rlanti-infectivemedication抗感染药物loccurrencekr()ns发生ltibialtbl胫骨的ltalustels距骨lsofttissuedegloving(套袖状的)软组织撕裂lmetaphyseal干骺端的lSevencasesweretreatedbydebridementandinternalfixationwithplate;19bylimitedintern
4、alfixationcombinedwithexternalfixation;and2bydelayedsurgery.lTheclinicaloutcomeswereevaluatedbytheBurwell-Charnleyscore.lResults:Allcaseswerefollowedupforfrom6to48months(average24months).lTheBurwell-Charnleyscoreofclinicaloutcomes:anatomicreductionachievedin12cases,functionalreductionin15,andunsatis
5、factoryreductionin1.lThehealingtimewasfrom2.5to11months(average4.7months).lTwocaseshaddelayedunion.AccordingtotheAmericanOrthopaedicFootandAnkleSociety(AOFAS)scalefortheanklejoint,therewereexcellentresultsin8cases,goodin14,fairin5andpoorin1.lComplicationsincludedfourcasesofskinsuperficialsloughing,t
6、woofsuperficialinfection,oneofdeepinfection,twoofdelayedfractureunionandtenofpost-traumaticarthritis.lThoroughdebridement,properuseofanti-infectivemedication,appropriatebonegrafting,andpostoperativeanklefunctionexercisecanreducetheoccurrenceofcomplications.ltrauma创伤lclassification分类;分级ldebridement清创
7、术、扩创术lanatomicreduction解剖复位lComplication并发症lsloughing蜕皮;脱落lpost-traumaticarthritisrats创伤后关节炎lThorough彻底地rlanti-infectivemedication抗感染药物loccurrencekr()ns发生ltibialtbl胫骨的;tibiatb胫骨ltalustels距骨lsofttissuedegloving软组织撕裂llowerlimbfractures下肢骨折ldegloving套袖状撕裂lmetaphyseal干骺端的larticulardepression关节压缩lweightb
8、earingarea负重区limplant内植物lapproach方法lcorrespondencen.通信;一致;相当lDOI:数字对象唯一标识符lbilaterallybailtrli双边地lmalleolusmlils踝踝lclinic临床;诊所临床;诊所lmotor 发动机发动机vehicle vikl(车辆)(车辆)accidentlOpenfracturescomprisesabout10%to30%ofallpilonfractures3.lThesefracturesareoftenassociatedwithsignificantsofttissuedegloving,met
9、aphysealbonedefectsandarticulardepression.lIntroductionPilonfractureconstitutes1%ofalllowerlimbfracturesandabout3%to10%oftibialfractures1,2.lItisusuallytheresultofhighenergyinjurytotheweightbearingareaofthelowerendofthetibiabythetalus.lConclusion:l Itisimportanttoperformappropriatesurgeriesforopenpi
10、lonfractureaccordingtofractureclassification,differentdamagetoskinandtissueandtimeintervalafterinjury.lKey words:Delayedoperation;Externalfixators;Fracturesopen;InternalfixatorsllInspiteofimprovementsinsurgicalapproachesandimplants,treatmentoftibialpilonfracturesremainschallenging4.lInthepresentstud
11、y,wediscussthemethods,timingandclinicaloutcomesofsurgicaltreatmentforopenpilonfractures.lAddress f or correspondence lXian-tieZeng,MD,DepartmentofTrauma,TianjinHospital,Tianjin,China300211Tel:0086-022-24151288;Fax:008602224151288;Email:Received:19July2010;accepted5October2010DOI:10.1111/j.1757-7861.
12、2010.00113.xlMaterials and MethodsPatient dataFrom April 2003 to July 2008,28 patients with open tibial pilon fractures were treated in our hospital.lThere were 21 men and 7 women with an average age of 36.5 years(range,1961 years).Ten patients were injured on the left side,17 on the right and 1 bil
13、aterally(a closed fracture of the right malleolus(踝)(踝)was not counted).lTheintervalbetweeninjuryandpresentationtoourclinicrangedfrom1to14hours(average,5.1hours).Themechanismsofinjurywerehigh-energyfallsin10cases,motorvehicleaccidentsin12,crushinginjury(挤压伤)in4cases,andsportsinjuriesin2.llThefractur
14、eswereclassifiedaccordingtotheAO/ASIFsystem:7wereclassifiedastypeC1,17typeC2,and4typeC3.lOpensofttissuedamagewasgradedaccordingtotheGustilosystem:4caseswereclassifiedasGustiloI,21GustiloII,2GustiloIIIA,and1GustiloIIIB.llacetabularstbjul髋臼的lfibular腓骨的;fibula腓骨lfemoral股骨的lCalcanealklkeinil跟骨的lcranioce
15、rebral,kreiniusiri:brl颅脑的lprotocol方法、协议lpresentingwith伴随lrestoration恢复ltibia胫骨lcancellouskns()ls松质骨linsertion插入lmodified改进的cloverleaf三叶草形lAnteromedial前内侧的medial内侧的lposterolateral后外侧的lateral外侧的lconstraint约束、限制keepinginmind牢记lanteroposterior前后的;正位(影像)lCombinedinjuriesincludedfibularfracturesin25cases,
16、spinalfracturesin2,upper-armfracturesin2,ribfracturesin2,femoralfracturein1,acetabularfracturein1,calcanealfracturein1,andcraniocerebraltraumain1.ldemonstrating显示Calcaneus(口Ki尼尔斯):跟骨lmetatarsal跖骨的lanklemortise踝关节lKirschner克氏pin克氏针lMe t h o d sOne of three different surgical protocols was performed i
17、n all patients,the choice being based on the condition of soft tissue,type of fracture and length of interval between injury and presentation for treatment.lD e b r i d e m e n t,o p e n reduction and internal fix at ion(ORIF)This method was applied in type C1 fractures presenting with low-grade sof
18、t tissue injury(Gustilo I,II)and interval between injury and presentation for treatment of less than 6 hours.lSevenpatients(fourtypeC1GustiloIandthreetypeC1GustiloII)weretreatedbythismethod.llSurgicaltreatmentofthepilonfractureswasinfoursteps:(a)restorationofthecorrectlengthandstabilizationofthefibu
19、la;l(b)reconstructionofthearticularsurfaceofthetibia;(c)insertionofcancellousautografts;and(d)stabilizationofthemedialaspectofthetibiawiththeuseofamodifiedcloverleafplate.lAnanteromedialincisionwasemployedtotreatthetibialcomponentandalateralorposterolateralincisiontotreatthefibularfracture.llThesurg
20、icalincisionswereplannedbasedontherequirementsofthefracturepattern,keepinginmindthesoft-tissueconstraintsoftheindividualinjury.lSkinclosurewasachievedwithnotension.lThetibialincisionswereclosedfirst.lIfnecessary,thefibularincisionswereleftfordelayedclosure.lOneofthesevenpatientsachievedprimaryclosur
21、eofthemedialincision,followedbydelayedclosureofthelateralone.lAtypicalcaseisshowninFig.1.lFigure 1 A49year-oldmanwithalow-energyopenpilonfracture(GustiloI&C1)l(a)Photographshowingopensofttissueinjury(GustiloI).l(b)PreoperativeanteroposteriorandlateralradiographsshowingPilonfractureoftypeC1.l(c)Posto
22、perativeradiographsshowingthefractureshavebeenanatomicallyreducedandfixedwithplates.l(d)Anteroposteriorandlateralradiographsdemonstratingfractureshavehealed1yearaftersurgery.lFigure 2 A22year-oldmanwithahigh-energyopenpilonfracture(GustiloII&C2)l(a)Photographshowingopensofttissueinjury(GustiloII).l(
23、b)PreoperativeradiographsshowingPilonfractureoftypeC2.ll(c)Postoperativeradiographsshowingthefractureshavebeenanatomicallyreducedandfixedwithexternalfixation,andthetibialfracturefixedwithlimitedinternalfixation.l(d)Anteroposteriorandlateralradiographsdemonstratingthefractureshavehealed1.5yearaftersu
24、rgery.lD e b r i d e m e n t,l i m i t e d O R I F a n d e x t e r n a l fi x a t i o nThismethodwasappliedintypeC2andtypeC3fracturespresentingwithhigh-gradesofttissueinjury(GustiloII,III)andintervalbetweeninjuryandpresentationfortreatmentoflessthan8hours.lNineteenpatients(16typeC2GustiloII,1typeC2G
25、ustiloIIIA,and2typeC3GustiloII)weretreatedbythismethod.lThepatientsweremanagedbyimmediate(直接的)debridementofthewound.lFibularfractureswerealwaysinternallyfixed,eitherwitha1/3tubular(管状的)plateor3.5mmcompressionplate.llExternalfixationwasappliedacrosstheanklejointwithpinsinthecalcaneus,metatarsalbone,a
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