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題名 | Surgical Treatment for Pilon Fracture of the Ankle-open Reduction and Internal Fixation=遠端脛骨併踝關節骨折之手術治療--觀血復位及內固定術 |
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作者 | 陳銀旺; 黃鵬如; 許崇義; 郭俊宏; 鄭裕民; 林森源; 陳蘭蕙; 江秀珠; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷期 | 14:1 1998.01[民87.01] |
頁次 | 頁31-35 |
分類號 | 416.26 |
關鍵詞 | 遠端脛骨併踝關節骨折; 手術治療; 觀血復位; 內固定術; Ankle fracture; Articular fracture; |
語文 | 英文(English) |
中文摘要 | 從1991到1994,有38個患者之39例遠端脛骨併踝關節骨折,包括29位男性、9位 女性, 平均年齡為 38.6 歲 (28 歲 -58 歲 ), 接受開刀復位手術,這些病人接受了平均 31.7 個月的追蹤 (22 個月 --44 個月 ), 檢查的項目包含站立的 X 光來確定關節炎情形 ,及臨床功能的分數評估。併發症包括有一例感染,二例部分皮膚壞死,有二例延遲癒合。 有 23 例發生創傷後關節炎 (佔 59%) 但僅有 4 例第四級的關節炎病人為差的功能分數, 而總滿意度為 82 %。 完全復位,牢靠的固定,和早日運動是腳踝骨折要有良好結果的必要 條件,而在 pilon fracture 其骨折的嚴重度和延遲的復位都是影響結果的因素。適當的開 刀術野以看到整個踝關節面, 腓骨的固定,足夠的骨頭移植以支持關節面,術中 X 光的確 定,術後一段時間的固定都是對要有良好臨床結果所需要的。 |
英文摘要 | From 1991 to 1994, 39 ankles of 38 patients underwent surgical open reduction and internal fixation for pilon fractures. These patients included 29 males and 9 females with an average age of 38.6 y/o (range 28 y/o-58 y/o). The follow up and evaluation period averaged 31.7 months (range 22Ms-44Ms), during which time a standing x-ray for arthrosis grading and functional scale was used for clinical evalution. Complications included 1 case of infection, 1 case of loss reduction, 2 cases of partial skin necrosis and 2 cases of delayed union. Post-traumatic arthritis occurred in 23 ankles (59%) but only 4 ankles of grade 4 arthrosis resulted in poor functional scale and the overall satisfactory rate was 82%. It was found that anatomic reduction, rigid fixation and early motion exercise are important to successful treatment of ankle fractures. Regarding pilon fracture, specifically the severity of fracture pattern and delay of reduction are important problems to overcome to ensure successful results. Therefore, adequate surgical approach for entire view of ankle joint, reduction and fixation of fibula, sufficient bone graft for articular suport, intraoperative x-ray check and postoperative immobilization are essential for the achievement of better clinical results. |
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