Song Shi-Xue, Bi Da-Peng, Tian Jing, Xie Bing
Department of Orthopaedics, General Hospital of Northern War Zone, Shenyang 110016, Liaoning, China.
Zhongguo Gu Shang. 2020 Mar 25;33(3):269-73. doi: 10.12200/j.issn.1003-0034.2020.03.017.
To explore clinical effects of fibular osteotomy and distal tibiofibular joint fusion for chronic valgus Pilon fracture malunion.
From January 2014 to January 2017, 8 patients with chronic valgus Pilon fracture malunion were treated, including 7 males and 1 female, aged from 20 to 47 years old, 6 patients on the left side and 2 patients on the right side; according to Rüedi-Allgöwer classification, 1 case was typeⅠ, 3 cases were typeⅡand 4 cases were type Ⅲ; the time from injury to admission ranged from 7 to 21 months. All deformities were evaluated individually based on pre-operatively weight bearing X-ray and 3D CT scan, and 3D printing model was also used for preliminary surgery. Weight-bearing X-ray showed posterior subluxation of ankle joint in 5 cases. There were 5 cases of fibular fracture at primary injury, and 2 cases of fibular fracture malunion. Fibular osteotomy and distal tibiofibular syndesmosis fusion strategy was performed to reduce articular surface congruency and correct lower limb alignment. Postoperative complication, fracture healing time and reduction were regularly recorded. Clinical function was evaluated according to American Orthopedic Foot and Ankle Society (AOFAS) at 1 year after operation.
All patients were followed up from 12 to 30 months. All incisions were primarily healed. No infection, neurovascular injuries or implant failure, lost of reduction occurred. Fracture healing time ranged from 13 to 19 weeks with good lower limb alignment. AOFAS score at 1 year after operation was 63 to 90 points, 1 patient got excellent result, 4 good and 3 fair. Seven patients returned to work at 6 to 14 months after opertaion.
For chronic valgus Pilon fractures malunion, fibular osteotomy and distal tibiofibular syndesmosis fusion could effectively restore congruency and alignment, correct lower limb alignment, improve ankle joint function, reduce occurrence of complication, and receive short term clinical effects.
探讨腓骨截骨术联合胫腓下关节融合术治疗慢性Pilon骨折外翻畸形愈合的临床效果。
选取2014年1月至2017年1月收治的8例慢性Pilon骨折外翻畸形愈合患者，其中男7例，女1例；年龄20～47岁，左侧6例，右侧2例；按照Rüedi-Allgöwer分型标准，Ⅰ型1例，Ⅱ型3例，Ⅲ型4例；受伤至入院时间7～21个月。所有畸形均根据术前负重X线片及三维CT扫描进行个体化评估，同时采用三维打印模型进行初步手术设计。负重X线片显示5例踝关节后脱位。初次受伤时5例合并腓骨骨折，2例腓骨骨折畸形愈合。采用腓骨截骨术联合胫腓下关节融合术，以恢复关节面的一致性并纠正下肢力线。定期记录术后并发症、骨折愈合时间及复位情况。术后1年根据美国足踝外科协会（AOFAS）评分标准评估临床功能。
所有患者均获随访，随访时间12～30个月。所有切口均一期愈合。未发生感染、神经血管损伤、内固定失败及复位丢失。骨折愈合时间为13～19周，下肢力线良好。术后1年AOFAS评分为63～90分，优1例，良4例，可3例。7例患者术后6～14个月恢复工作。
对于慢性Pilon骨折外翻畸形愈合，腓骨截骨术联合胫腓下关节融合术可有效恢复关节面一致性及力线，纠正下肢力线，改善踝关节功能，减少并发症发生，获得较好的近期临床效果。
