[分期治疗开放性Pilon骨折合并软组织缺损的疗效观察]

Liu Zhong, Xu Hong, Zhang Zhao, Teng Yunsheng, Wu Meng, Tao Shenglin

Department of Traumatic Orthopaedics, Xi'an Ordnance Industrial 521 Hospital, Institute of Hand Microsurgery of Shaanxi, Xi'an Shaanxi 710065, PR China.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Oct;27(10):1185-9.

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 x 5 cm to 18 cm x 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 degrees (range, 26-57 degrees). 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.

目的

探讨分期治疗开放性Pilon骨折合并软组织缺损的疗效。

方法

2007年6月至2012年12月，治疗18例开放性Pilon骨折合并软组织缺损患者。其中男性14例，女性4例，平均年龄35岁（19 - 55岁）。致伤原因包括高处坠落12例、交通事故4例、机器碾压2例。按AO分型，B2型骨折1例，B3型骨折3例，C1型骨折5例，C2型骨折5例，C3型骨折4例。16例合并腓骨骨折（单纯腓骨骨折14例，腓骨骨折合并贯通伤2例）。按Gustilo分型，软组织损伤均为IIIB型。一期行清创、负压封闭引流联合外固定；对单纯腓骨骨折行切开复位内固定。二期行Pilon骨折及腓骨骨折合并贯通伤的切开复位内固定，同时应用面积为6 cm×5 cm至18 cm×14 cm的皮瓣修复软组织缺损，供区采用植皮修复。

结果

2例皮瓣部分坏死，其余16例皮瓣完全成活。供区切口一期愈合，植皮完全成活。平均随访时间12个月（6 - 24个月）。X线片显示骨折愈合时间为5至8个月（平均6个月）。未发现内固定失败。末次随访时，踝关节平均活动度为37°（26° - 57°）。按美国足踝外科协会（AOFAS）评分标准，平均评分为80.2分（72 - 86分）。2例（11%）发生创伤性关节炎。