胫骨Pilon骨折及创伤性关节炎防治的临床研究
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摘要
目的：为Pilon骨折探索出一较为合理的治疗方案，从而最大限度地减少创伤性关节炎的发生，恢复关节的功能。
方法：本文文献部分系统地介绍了Pilon骨折的相关解剖、发病率、危险因素以及发病机制等。着重对Pilon骨折的诊断分型及国内外各种治疗方法进行了系统回顾；临床研究部分则将2002～2004年收治的21例Pilon骨折随机分为两组，实行切开复位内固定后治疗组早期被动功能锻炼(CPM)加中药熏洗患部，对照组只实施患肢主动功能练习。
结果：通过文献研究总结出一条合理的Pilon骨折的治疗方案，切开关节面解剖复位内固定，术后早期被动活动踝关节，外加中药熏洗患部。两组患者按Mazur评分标准，经过5个月～18个月的随访，治疗组优良率达69.2％，而对照组只达50％。
结论：切开关节面解剖复位，采用钢板内固定，术后早期踝关节被动功能锻炼加中药熏洗患部都是Pilon骨折较为理想的治疗方法，能有效地预防创伤性关节炎的发生，改善关节功能。
Objective: To seek out an optical treatment scheme of Pilon fracture, and then to prevent posttraumatic arthritis ,restore function of ankle .
Methods: In the literature section of this academic thesis ,author reviewed systematically the anatomy , mobility , dangerous factors and pathogenesis of Pilon fracture and so on .And specially stressed on diagnosis , classification and treatment of Pilon fracture .In clinical study section ,2leases which collected from 2002 to 2004 had been randomed into treatment -group and control-group. 13 in treatment and 8 in another. After ORIF ,cases in treatment group were managed by early CPM and xtinxi ,cases in control were treated only by early active motion .
Result: We made out a rational treatment scheme of Pilon fracture through literature study: open reduction internal fixation , postoperative CPM and local xunxi ,which proved useful optimal by our clinical study .According to Mazur score, the rate of excellent was 69.2%, while50 %in control.
Conclusion: Open reduction and internal fixation , postoperative CPM and local xunxi with Chinese medicine is an ideal management of Pilon fracture .It can effectively prevent the posttraumatic arthritis .
方法：本文文献部分系统地介绍了Pilon骨折的相关解剖、发病率、危险因素以及发病机制等。着重对Pilon骨折的诊断分型及国内外各种治疗方法进行了系统回顾；临床研究部分则将2002～2004年收治的21例Pilon骨折随机分为两组，实行切开复位内固定后治疗组早期被动功能锻炼(CPM)加中药熏洗患部，对照组只实施患肢主动功能练习。
结果：通过文献研究总结出一条合理的Pilon骨折的治疗方案，切开关节面解剖复位内固定，术后早期被动活动踝关节，外加中药熏洗患部。两组患者按Mazur评分标准，经过5个月～18个月的随访，治疗组优良率达69.2％，而对照组只达50％。
结论：切开关节面解剖复位，采用钢板内固定，术后早期踝关节被动功能锻炼加中药熏洗患部都是Pilon骨折较为理想的治疗方法，能有效地预防创伤性关节炎的发生，改善关节功能。
Objective: To seek out an optical treatment scheme of Pilon fracture, and then to prevent posttraumatic arthritis ,restore function of ankle .
Methods: In the literature section of this academic thesis ,author reviewed systematically the anatomy , mobility , dangerous factors and pathogenesis of Pilon fracture and so on .And specially stressed on diagnosis , classification and treatment of Pilon fracture .In clinical study section ,2leases which collected from 2002 to 2004 had been randomed into treatment -group and control-group. 13 in treatment and 8 in another. After ORIF ,cases in treatment group were managed by early CPM and xtinxi ,cases in control were treated only by early active motion .
Result: We made out a rational treatment scheme of Pilon fracture through literature study: open reduction internal fixation , postoperative CPM and local xunxi ,which proved useful optimal by our clinical study .According to Mazur score, the rate of excellent was 69.2%, while50 %in control.
Conclusion: Open reduction and internal fixation , postoperative CPM and local xunxi with Chinese medicine is an ideal management of Pilon fracture .It can effectively prevent the posttraumatic arthritis .
引文
1、Ramsay PL et al Change in tibiatalar area of contact caused by lateral talar shift J Bone Joint Surg(AM) 1976; 58:356
2、Nelson GE Blood supply of the human tiabia J Bone Surg(AM)1960;42:625
3、Kelley PT et al The blood supply of the tiabia Surg Clin North AM 1961;41:1463
4、李汉云 等 胫骨骨膜骨瓣的应用解剖学研究。临床应用解剖学杂志 1983；1：31
5、Macnab I Blood supply of the tiabia J Bone Joint Surg(Br) 1957;39:799
6、Dirschl DR, Adams GI J orthop trauma 1997;11(7)92∽99
7、侯筱魁，张峻，孙月华 CT重建在骨关节损伤中的应用 中华矫形外科杂志2000年5月第7卷5：421∽423
8、Tornetta M P, Garap J, Axial computer tomography of pilon fracture. Clin Orthop 1985,273
9、Ruedi TP, Allgower M. Injury;1(2):92∽99
10、Ruedi TP, Allgower M.。Cli n nOrthop, 1979;138: 105∽110
11、Ovadia DN, Beals RK, Classification Ao des fractures Berlin,Springer-vedag,1987,170-179
12、Mast JW, Spiegel PG, Pappas JN: Clin Orthop 230:68,1998
13、Muller ME, Nazarian S, Koch P, et al ends. 《The Comprehensive
Classification of Fracture of Long Bones》. Springer-Verlag:Berlin, 1990:170-179
14、Anoymous.J O rthop Trauma,1997;11(7):471-476
15、Kellam JM, Wadda TP, Fracture of the distal metaphysis with intraarticular extension:The distal explosion fracture.J Trauma 1979,19:593
16、Ruedi T Fracture of the lower end of the tiabia into the ankle joint:Results 9 yeas after open reduction and internal fixation Injuty,1973,5;130-134
17、Mark G Mcdonald MD, Ronaldc Burgess,et al Ilizarov Treatment of pilon fracture Clin Orthop,1996,325:232-238
18、Brumback RJ, Mcgarvey WC.Fracture of the tiabia plainfond. O rthop Clin North Amercian 1995,26:273-285
19、尚天裕，《中国接骨学》天津科学技术出版社 第一版 1995：275
20、李也白，李晓阳，53例Pilon骨折手术与非手术治疗方法的比较 中华创伤杂志 2001年8月第17卷(8)：485∽487
21、Wyrsch B, McFerran MA, McAndrew M, et al. Operative treatment of the tiabia plafond fracture. Clin Orthop, 1996,78:1646-1657
22、Tometta P, Weiner L, Bergman M, et al. Pilon fractures:Treatment with combined internal and external fixation J Orthop Trauma, 1993,7:489-496
23、Sirkin M Sanders R, DiPasquale et al.A staged protocol for soft tissue management in the treatment in the complex pilon fractures. J Orthop Trauma, 1999,13(2):78-84
24、Treadwell JR, Fallat LM. Dynamic unilateral distraction fixation:surgical management of tiabia pilon fractures. J Foot Ankle Surg, 1994,33:438-442
25、DiChristina D, Riemer BL, Butterfield SL, et al. pilon fractures treated with an articulated external fixator: a preliminary
report. Orthopedics, 1996, 19(12):1019-1024
26、Mandracchia VJ, Evans RD, Nelson SC, et al. pilon fracture of the distal tiabia. Clin Podiatr Med Surg 1999, 16(4):743-767
27、Ruedi TP, Allgower M. Fractures of the lower end of the tiabia into the ankle-jiont. Injury, 1969, 82-92
28、Chen YW, Huang PJ, Hsu CY, et al. Surgical treatment for pilon fracture of the ankle-open reduction and internal fixation. Kao Hsiung Ⅰ Hsueh tsa Chin, 1998, 14(1):31-35
29、Morgan SJ, Thordarson DB, Shepherd LE. Salvage of tiabia pilon fractures using fusion of ankle with a 90 degree cannulated blade-plate:a preliminary report. Foot Ankle Int, 1999, 20(6):357-378
30、Mazur JM, Schwartz E, Simon SR. Ankle arthrodesis:Long-term follow-up with gait analysis. J Bone Surg(Am) 1979,61:2236-2245
31、Barbieri R, Schenk R, Koval K,et al.Hybid external fixation in the treatment of tiabia plafond fractures. Clin Orthop.1996,(332):16-22
32、Babis CC, Vayanos ED, Papaioannou N et al. Result of surgical treatment of tiabia plapond fracture.Clin Orthop,1997,(341):99-105
33、Teeny SM, Wiss DA.Open reduction and internal fixation of tibia plapond fracture: variables contributing to poor results and complications. Clin Orthop,2002,33:231-245
34、Patterson MJ, Two-staged delay open reduction and internal fixation of severe pilon fractures.J Orthop Trauma,1993,13:85-91
35、Sirkin M, Sanders R, DiPasquale T, et al. A stage protocal for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma, 1999,13:78-84
36、Egol KA. Wolinsky P, KJ. Open reduction and internal fixation of tibia pilon fractures. Foot Ankle Clin, 2000,5:873-885
37、Egol KA. Wolinsky P, KJ.Open reduction and internal fixation of tibia pilon fractures. Foot Ankle Clin, 2000,5:873-885
38、Salter RB, Smmonds DF, Malconlm BW,et,al. The biological effect of continous passive motion of healing of thickness defects in articular cartilage. An exprimental investigation in the rabbit J Bone Joint Surg(Am) 1980,62:1232-1251
39、Babiis et The operative treatment of intraarticular fractures of the lower end of the tibia J Clin Orthop,1979,120:112-115
40、Redrawn from Heim,U The pilon fracture: classsification. Surgical Techniques, Result.Philadephia,W.B.Saunders,1995
41、Lambett KL. The weight-beating function of the fibula: a strain gauge study J Bone Surg(Am),1971,53:507
42、Morgan SJ, Thordarson DB, Shepherd LE. Salvage of tibia pilon fractures using fusion of the ankle with a 90 degrees cannulated blade-plate: a preminary report. Foot Ankle Int,1999,20(6):375-378
43、Ovidia DN, Beals RK, Fractures of the tibial plapond J Bone Jone Surg (Am),1986,68:543-551
44、Ruedi TP, Allgower M. The operative treatment of intraarticular fractures of the lower end of the tibia J Clin Orthop,1979,138:105-110
45、王亦骢主编 膝关节外科的基础与临床 人民卫生出版社 1996：565-566
46、武伟等 活血化瘀治疗血栓闭塞性脉管炎血液流变学观察 微循环杂志，1995 3(2)：94
2、Nelson GE Blood supply of the human tiabia J Bone Surg(AM)1960;42:625
3、Kelley PT et al The blood supply of the tiabia Surg Clin North AM 1961;41:1463
4、李汉云 等 胫骨骨膜骨瓣的应用解剖学研究。临床应用解剖学杂志 1983；1：31
5、Macnab I Blood supply of the tiabia J Bone Joint Surg(Br) 1957;39:799
6、Dirschl DR, Adams GI J orthop trauma 1997;11(7)92∽99
7、侯筱魁，张峻，孙月华 CT重建在骨关节损伤中的应用 中华矫形外科杂志2000年5月第7卷5：421∽423
8、Tornetta M P, Garap J, Axial computer tomography of pilon fracture. Clin Orthop 1985,273
9、Ruedi TP, Allgower M. Injury;1(2):92∽99
10、Ruedi TP, Allgower M.。Cli n nOrthop, 1979;138: 105∽110
11、Ovadia DN, Beals RK, Classification Ao des fractures Berlin,Springer-vedag,1987,170-179
12、Mast JW, Spiegel PG, Pappas JN: Clin Orthop 230:68,1998
13、Muller ME, Nazarian S, Koch P, et al ends. 《The Comprehensive
Classification of Fracture of Long Bones》. Springer-Verlag:Berlin, 1990:170-179
14、Anoymous.J O rthop Trauma,1997;11(7):471-476
15、Kellam JM, Wadda TP, Fracture of the distal metaphysis with intraarticular extension:The distal explosion fracture.J Trauma 1979,19:593
16、Ruedi T Fracture of the lower end of the tiabia into the ankle joint:Results 9 yeas after open reduction and internal fixation Injuty,1973,5;130-134
17、Mark G Mcdonald MD, Ronaldc Burgess,et al Ilizarov Treatment of pilon fracture Clin Orthop,1996,325:232-238
18、Brumback RJ, Mcgarvey WC.Fracture of the tiabia plainfond. O rthop Clin North Amercian 1995,26:273-285
19、尚天裕，《中国接骨学》天津科学技术出版社 第一版 1995：275
20、李也白，李晓阳，53例Pilon骨折手术与非手术治疗方法的比较 中华创伤杂志 2001年8月第17卷(8)：485∽487
21、Wyrsch B, McFerran MA, McAndrew M, et al. Operative treatment of the tiabia plafond fracture. Clin Orthop, 1996,78:1646-1657
22、Tometta P, Weiner L, Bergman M, et al. Pilon fractures:Treatment with combined internal and external fixation J Orthop Trauma, 1993,7:489-496
23、Sirkin M Sanders R, DiPasquale et al.A staged protocol for soft tissue management in the treatment in the complex pilon fractures. J Orthop Trauma, 1999,13(2):78-84
24、Treadwell JR, Fallat LM. Dynamic unilateral distraction fixation:surgical management of tiabia pilon fractures. J Foot Ankle Surg, 1994,33:438-442
25、DiChristina D, Riemer BL, Butterfield SL, et al. pilon fractures treated with an articulated external fixator: a preliminary
report. Orthopedics, 1996, 19(12):1019-1024
26、Mandracchia VJ, Evans RD, Nelson SC, et al. pilon fracture of the distal tiabia. Clin Podiatr Med Surg 1999, 16(4):743-767
27、Ruedi TP, Allgower M. Fractures of the lower end of the tiabia into the ankle-jiont. Injury, 1969, 82-92
28、Chen YW, Huang PJ, Hsu CY, et al. Surgical treatment for pilon fracture of the ankle-open reduction and internal fixation. Kao Hsiung Ⅰ Hsueh tsa Chin, 1998, 14(1):31-35
29、Morgan SJ, Thordarson DB, Shepherd LE. Salvage of tiabia pilon fractures using fusion of ankle with a 90 degree cannulated blade-plate:a preliminary report. Foot Ankle Int, 1999, 20(6):357-378
30、Mazur JM, Schwartz E, Simon SR. Ankle arthrodesis:Long-term follow-up with gait analysis. J Bone Surg(Am) 1979,61:2236-2245
31、Barbieri R, Schenk R, Koval K,et al.Hybid external fixation in the treatment of tiabia plafond fractures. Clin Orthop.1996,(332):16-22
32、Babis CC, Vayanos ED, Papaioannou N et al. Result of surgical treatment of tiabia plapond fracture.Clin Orthop,1997,(341):99-105
33、Teeny SM, Wiss DA.Open reduction and internal fixation of tibia plapond fracture: variables contributing to poor results and complications. Clin Orthop,2002,33:231-245
34、Patterson MJ, Two-staged delay open reduction and internal fixation of severe pilon fractures.J Orthop Trauma,1993,13:85-91
35、Sirkin M, Sanders R, DiPasquale T, et al. A stage protocal for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma, 1999,13:78-84
36、Egol KA. Wolinsky P, KJ. Open reduction and internal fixation of tibia pilon fractures. Foot Ankle Clin, 2000,5:873-885
37、Egol KA. Wolinsky P, KJ.Open reduction and internal fixation of tibia pilon fractures. Foot Ankle Clin, 2000,5:873-885
38、Salter RB, Smmonds DF, Malconlm BW,et,al. The biological effect of continous passive motion of healing of thickness defects in articular cartilage. An exprimental investigation in the rabbit J Bone Joint Surg(Am) 1980,62:1232-1251
39、Babiis et The operative treatment of intraarticular fractures of the lower end of the tibia J Clin Orthop,1979,120:112-115
40、Redrawn from Heim,U The pilon fracture: classsification. Surgical Techniques, Result.Philadephia,W.B.Saunders,1995
41、Lambett KL. The weight-beating function of the fibula: a strain gauge study J Bone Surg(Am),1971,53:507
42、Morgan SJ, Thordarson DB, Shepherd LE. Salvage of tibia pilon fractures using fusion of the ankle with a 90 degrees cannulated blade-plate: a preminary report. Foot Ankle Int,1999,20(6):375-378
43、Ovidia DN, Beals RK, Fractures of the tibial plapond J Bone Jone Surg (Am),1986,68:543-551
44、Ruedi TP, Allgower M. The operative treatment of intraarticular fractures of the lower end of the tibia J Clin Orthop,1979,138:105-110
45、王亦骢主编 膝关节外科的基础与临床 人民卫生出版社 1996：565-566
46、武伟等 活血化瘀治疗血栓闭塞性脉管炎血液流变学观察 微循环杂志，1995 3(2)：94
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