Marsh J L, Bonar S, Nepola J V, Decoster T A, Hurwitz S R
Department of Orthopaedics, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
J Bone Joint Surg Am. 1995 Oct;77(10):1498-509. doi: 10.2106/00004623-199510000-00004.
We performed a prospective study of forty-nine displaced fractures of the tibial plafond in forty-eight patients managed, at three centers, with an articulated external fixator placed medially across the ankle joint. Forty ankles had interfragmental screw fixation of a reduced articular fracture, and fourteen ankles had bone-grafting. The average duration of external fixation was twelve weeks. All of the fractures healed (one after delayed bone-grafting). There were no infections in any of the operative or traumatic wounds over the tibia. Two wound infections over the fibula resolved with treatment. Eight patients were managed with antibiotics for a pin-site infection, and two patients had curettage and débridement of a pin site in the hindfoot after removal of the fixator. Thirty patients (thirty-one ankles) completed two-year data sheets at an average of thirty months after the injury. The average ankle score was 67 points. Twenty-one patients had grade-0 or 1 osteoarthrosis and nine had grade-2 or 3. One ankle had been treated with an arthrodesis. These data suggest that the prevalence of early complications associated with severe fractures of the tibial plafond and their treatment can be decreased with use of an articulated external fixator combined with limited internal fixation. We concluded that this technique of external fixation is a satisfactory technique for the treatment of these fractures.
我们对48例患者的49处胫骨平台移位骨折进行了一项前瞻性研究，这些患者在三个中心接受治疗，通过在内侧跨过踝关节放置的铰链式外固定器进行治疗。40个踝关节对复位后的关节骨折进行了骨折块间螺钉固定，14个踝关节进行了植骨。外固定的平均持续时间为12周。所有骨折均愈合（1例在延迟植骨后愈合）。胫骨上的任何手术伤口或创伤伤口均未发生感染。腓骨上的两处伤口感染经治疗后痊愈。8例患者因针道感染接受了抗生素治疗，2例患者在拆除固定器后对后足的针道进行了刮除和清创。30例患者（31个踝关节）在受伤后平均30个月完成了两年的数据表。踝关节平均评分为67分。21例患者有0级或1级骨关节炎，9例有2级或3级骨关节炎。有1个踝关节接受了关节融合术治疗。这些数据表明，使用铰链式外固定器结合有限内固定可以降低与胫骨平台严重骨折及其治疗相关的早期并发症的发生率。我们得出结论，这种外固定技术是治疗这些骨折的一种令人满意的技术。
