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find Keyword "Pilon骨折" 17 results
  • EFFECTIVENESS OBSERVATION OF STAGED TREATMENT OF OPEN Pilon FRACTURE COMBINED WITH SOFT TISSUE DEFECT

    Objective To explore the effectiveness of staged treatment of open Pilon fracture combined with soft tissue defect. Methods Between June 2007 and December 2012, 18 cases of open Pilon fracture combined with soft tissue defect were treated. There were 14 males and 4 females with an average age of 35 years (range, 19-55 years). The causes of injury included falling from height in 12 cases, traffic accident in 4 cases, and crushing by machine in 2 cases. According to AO classification, 1 case was classified as type B2 fracture, 3 cases as type B3 fracture, 5 cases as type C1 fracture, 5 cases as type C2 fracture, and 4 cases as type C3 fracture. Sixteen cases accompanied by fibular fracture (14 cases of simple fibular fracture and 2 cases of communicated fibular fracture). According to Gustilo classification, the soft tissue injuries were all type IIIB. In first stage, debridement and vaccum sealing drainage combined with external fixation were performed; open reduction and internal fixation of simple fibular fracture were used. In second stage, open reduction and internal fixation of Pilon fracture and communicated fibular fracture were performed, and the flaps of 6 cm × 5 cm to 18 cm × 14 cm were applied to repair soft tissue defect at the same time. The donor site was repaired by skin graft. Results Partial necrosis occurred in 2 flaps, the other 16 flaps survived completely. The incisions of donor sites healed by first intention, the skin graft survived completely. The average follow-up interval was 12 months (range, 6-24 months). The X-ray films showed that the bone healing time ranged from 5 to 8 months (mean, 6 months). No internal fixation failure was found. At last follow-up, the average range of motion of the ankle joint was 37° (range, 26-57°). According to the American Orthopedic Foot and Ankle Society (AOFAS) scale, the average score was 80.2 (range, 72-86). Traumatic arthritis occurred in 2 cases (11%). Conclusion The staged treatment has the advantages of accurate evaluation of soft tissue injury, shortened cure time, good reduction of the articular surface, and reduced incidence of infection, so it is an optimal method to treat open Pilon fracture combined with soft tissue defect.

    Release date:2016-08-31 04:05 Export PDF Favorites Scan
  • EFFECTIVENESS AND BIOMECHANICAL ANALYSIS OF THREE FIXATION METHODS IN TREATMENT OF POSTERIOR Pilon FRACTURES

    Objective To investigate the effectiveness and biomechanical analysis of 3 fixation methods of screw anterior-posterior fixation (SAPF), screw posterior-anterior fixation (SPAF), and buttress plate fixation (BPF) in treatment of posterior Pilon fractures. Methods Fifteen fresh-frozen skeleto-ligamentous lower leg specimens were harvested to establish the models of posterior Pilon fracture, and then fracture was fixed with BPF (n=5), SAPF (n=5), and SPAF (n=5). Vertical force was loaded to internal fixation failure in a speed of 1 cm/minute with servohydraulic testing machine. The instantaneous loads of 1 mm and 2 mm steps and the failure modes were recorded. Between May 2008 and December 2011, 56 patients with posterior Pilon fracture were treated with SAPF (SAPF group) in 11 cases, or SPAF (SPAF group) in 26 cases, or BPF (BPF group) in 19 cases. There was no significant difference in age, gender, injury cause, side, disease duration, and complications among groups (P gt; 0.05). Clinical and radiographic examinations were used to assess the reduction and healing of fracture; the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) were used to evaluate the functional outcomes. Results No breaking or bending was observed in all specimens, fixation failure was caused by cancellous bone compression. The instantaneous loads of 1 mm and 2 mm steps were the largest in BPF group, larger in SPAF group, and smallest in SAPF group, showing significant differences among 3 groups (P lt; 0.05). A total of 47 cases were followed up 16-54 months (9 in SAPF group, 22 in SPAF group, and 16 in BPF group), with a mean time of 35.2 months. Fixation failure was found in 2 cases of SAPF group; the other cases obtain bony union within 3 to 4 months (mean, 3.2 months) with no fixation failure. The AOFAS score was significantly lower in SAPF group than in SPAF and BPF groups (P lt; 0.05), but no significant difference was found between SPAF and BPF groups (P gt; 0.05). The VAS score was significantly higher in SAPF group than in SPAF and BPF groups (P lt; 0.05), but no significant difference was found between SPAF and BPF groups (P gt; 0.05). Conclusion SAPF could not reach enough fixation strength for the posterior Pilon fracture; both SPAF and BPF could reach rigid fixation, and have good effectiveness. And from the biomechanical points, BPF could reach better fixation strength than screw fixations.

    Release date:2016-08-31 04:05 Export PDF Favorites Scan
  • 封闭式负压引流联合游离股前外侧皮瓣修复Pilon骨折术后软组织缺损

    目的 总结封闭式负压引流(vacuum sealing drainage,VSD)联合游离股前外侧皮瓣移植修复Pilon骨折术后软组织缺损的疗效。 方法2008年3月-2011年7月,收治Pilon骨折术后软组织缺损患者23例。男15例,女8例;年龄16~63岁,平均32.2岁。Pilon骨折术后至此次手术时间为1~6个月,平均3.2个月。创面伴骨、钢板螺钉外露,创面范围9 cm × 5 cm~13 cm × 7 cm。VSD治疗后,切取大小为10 cm × 6 cm~15 cm × 9 cm的游离股前外侧皮瓣移植修复创面。供区直接缝合(6例)或游离植皮(17例)修复。 结果术后3例皮瓣发生静脉危象,其余皮瓣均顺利成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合,皮片除1例出现边缘部分坏死外,其余均成活。23例均获随访,随访时间6~24个月,平均11.5个月。皮瓣质地柔软,外形、色泽好。术后6个月踝关节功能按照美国矫形足踝协会(AOFAS)评分系统评定:获优11例,良8例,可3例,差1例;优良率为82.6%。 结论应用VSD联合游离股前外侧皮瓣修复Pilon骨折术后软组织缺损,可缩短治疗周期,提高手术成功率,最大限度恢复肢体功能。

    Release date:2016-08-31 04:22 Export PDF Favorites Scan
  • 手术治疗胫骨Pilon骨折

    目的 探讨胫骨Pilon骨折后石膏托外固定或局麻下行跟骨骨钉牵引治疗后,行切开复位内固定术治疗的临床疗效。 方法 1996年8月~2005年1月,收治Pilon骨折患者22例。男16例,女6例。年龄17~55岁,平均35.5岁。采用RuediAllgower分型:Ⅰ型3例, Ⅱ型15例,Ⅲ型4例。伤后予以石膏托外固定或在局麻下行跟骨骨钉牵引治疗7~14 d后,采用切开复位内固定术治疗。 结果 术后切口均Ⅰ期愈合。患者均获随访1年5个月~3年,平均2.4年。X线片示术后10~32周骨折愈合,平均15周。根据Mazur踝关节症状和功能评分系统评定:优12例,良5例,可3例,差2例,优良率为77.2%。术后并发慢性骨髓炎1例,踝内翻1例,创伤性关节炎改变15例。 结论 术前评估软组织损伤情况,选择合适治疗时机,根据胫骨Pilon骨折类型选择适当的内固定方式可获得良好复位,减少并发症的发生。

    Release date:2016-09-01 09:23 Export PDF Favorites Scan
  • REPAIR OF SOFT TISSUE DEFECT BY REVERSE SOLEUS MUSCLE FLAP AFTER PILON FRACTURE FIXATION

    Objective To investigate the clinical effect of the reverse transposition of pedicled soleus muscle flap in repairing soft tissue defects after Pilon fracture fixation. Methods From May 2002 to June 2006, 14 patients (11 males, 3 females; aging 2050 years) with soft tissue defects afterPilon fracture fixationunderwent repairing operations with the reverse soleus muscle flaps. The soft tissue defects ranged from 7.0 cm×3.5 cm to 100 cm×60 cm. Of the patients, Pilon fractures were treated by internal fixations in 9 cases, open Pilon fractures weretreated by external fixations in 5 cases. The area of muscle flap ranged from 8.5 cm×5.5 cm to 12.5 cm×7.5 cm. Results All patients achieved primary healings, and the grafting skin survived. Twelve flaps survived completely but 2 flapshad mildinfection, which survived after dressing change. Eleven patients were followed up for 3 to 26 months, averaged 15 months. The flap appearances were good and smooth without ulceration. The dorsiflexion ranges of ankle joint were 10-25°, and plantar flexion ranges were 15-40°. The gait was normal. Conclusion The reverse soleus muscle flap is no need to reveal blood vessel pedicle and has constant position of anatomy. It has big muscle belly, convenient to move and circuitation 180°. It is profitable to reduce infection rate and to promote wound healing to raise local osteotylus.

    Release date:2016-09-01 09:23 Export PDF Favorites Scan
  • 急诊手术修复胫骨开放性Pilon骨折

    Release date:2016-09-01 09:29 Export PDF Favorites Scan
  • TREATMENTS OF TIBIAL PILON FRACTURES WITH A COMBINATION OF LIMITED INTERNAL FIXATION AND EXTERNAL FIXATION

    Objective To summarize the effect and complication of treatment for Pilon fracture using limited internal fixation combined with external fixation. Methods From April 1996 to June 2003, 20 patients with Pilon fracture were treated with limited internal fixation combined with external fixation as the treatment group and 22 patients with Pilon fracture with other methods as the control group. The X-ray films, clinical effect and complication were analyzed and compared between 2 groups. Results All cases were followed up for 8 to 26 months(15.2 months on average). According to Helfet’s criterion forclinical effect, the excellent and good rates were 75% in the treatment group and 72.7%in the control group, being no significant difference (Pgt;0.05). According to Burwell-charnley criterion for reduction, the X-ray film resultsshowed the excellent and good rates were 90% in the treatment group and 86.4% in the control group, being no significant difference (Pgt;0.05). But there was significant difference in complications between 2 groups (Plt;0.05). Conclusion Limited internal fixation combined with external fixation is better in resuming ankle joint function and remarkably reducing complication, especially in reducing soft tissue complication and collapse of bone joint; it is useful in the treatment of Pilon fracture.

    Release date:2016-09-01 09:30 Export PDF Favorites Scan
  • 心理干预对Ⅱ、Ⅲ型Pilon骨折患者焦虑的影响

    目的 探讨心理干预对Ⅱ、Ⅲ型Pilon骨折患者焦虑的影响。 方法 将2007年1月-2011年12月收治的46 例患者按照随机数字表分为对照组和试验组。对照组行常规骨科治疗及护理,试验组在此基础上给予心理行为干预,并在干预前后用焦虑自评量表(SAS)进行评分比较。 结果 干预前两组焦虑自评量表差异无统计学意义(P>0.05);干预后试验组焦虑评分显著低于对照组(P<0.05)。 结论 实施心理行为干预可降低Ⅱ、Ⅲ型Pilon骨折患者焦虑程度,提高患者的生命质量。

    Release date:2016-09-07 02:37 Export PDF Favorites Scan
  • Pilon骨折的手术治疗

    Pilon骨折由于创伤能量大,胫骨远端软组织覆盖少,给临床治疗带来困难。手术治疗Pilon骨折的方法包括早期切开复位内固定(ORIF)、有限内固定结合外固定、分步延期ORIF和微创技术。虽然治疗手段上不断修正和更新,但是仍存在并发症多、伤残率高等问题。现就近年Pilon骨折手术治疗研究作一综述。

    Release date:2016-09-08 09:13 Export PDF Favorites Scan
  • 锁定加压接骨板治疗Pilon骨折

    【摘要】 目的 总结锁定加压接骨板治疗Pilon骨折的疗效。 方法 2004年1月-2008年6月,将48例Pilon骨折患者随机分为急诊手术组和延期手术组,急诊手术组于伤后12 h之内手术,延期手术组于受伤7 d后手术。 结果 经过治疗所有患者骨折复位满意,无血管、神经损伤发生,无内固定物断裂、螺丝钉进入关节间隙发生,无接骨板外露、感染等早期并发症,两组优良率无统计学意义(Pgt;0.05);急诊手术组平均住院时间、消肿时间、骨折愈合时间均显著少于延期手术组,有统计学意义(Plt;0.05)。 结论 采用锁定加压接骨板治疗Pilon 骨折可取得满意的疗效,只要正确选择手术时机,术中精细的操作,可防治并发症。

    Release date:2016-09-08 09:51 Export PDF Favorites Scan
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