Pilon骨折的外科治療英文PPT加翻譯[通用]

1、Pilon骨折的外科治療英文PPT加翻譯trauma創(chuàng)傷classification分類；分級debridement清創(chuàng)術(shù)、擴(kuò)創(chuàng)術(shù)anatomic reduction解剖復(fù)位the Arbeitsgemeinschaft fr osteosynthesefragen瑞士骨折內(nèi)固定協(xié)會/AOBurwell-Charnley score骨折復(fù)位放射學(xué)評價(jià)標(biāo)準(zhǔn)1965Orthopaedic骨科的；整形外科的Complication并發(fā)癥sloughing蛻皮；脫落post-traumatic arthritisrats創(chuàng)傷后關(guān)節(jié)炎Thorough徹底地ranti-infective medicati

2、on抗感染藥物occurrence kr()ns發(fā)生tibial tbl脛骨的talustels距骨soft tissue degloving(套袖狀的) 軟組織撕裂metaphyseal干骺端的Seven cases were treated by debridement and internal fixation with plate; 19 by limited internal fixation combined with external fixation; and 2 by delayed surgery. The clinical outcomes were evaluated

3、by the Burwell-Charnley score.Results: All cases were followed up for from 6 to 48 months (average 24 months). The Burwell-Charnley score of clinical outcomes: anatomic reduction achieved in 12 cases, functional reduction in 15, and unsatisfactory reduction in 1.The healing time was from 2.5 to 11 m

4、onths (average 4.7 months). Two cases had delayed union. According to theAmerican Orthopaedic Foot and Ankle Society (AOFAS) scale for the ankle joint, there were excellent results in 8 cases,good in 14, fair in 5 and poor in 1. Complications included four cases of skin superficial sloughing, two of

5、 superficial infection, one of deep infection, two of delayed fracture union and ten of post-traumatic arthritis.Thorough debridement, proper use of anti-infective medication, appropriate bone grafting, and postoperative ankle function exercise can reduce the occurrence of complications.trauma創(chuàng)傷clas

6、sification分類；分級debridement清創(chuàng)術(shù)、擴(kuò)創(chuàng)術(shù)anatomic reduction解剖復(fù)位Complication并發(fā)癥sloughing蛻皮；脫落post-traumatic arthritisrats創(chuàng)傷后關(guān)節(jié)炎Thorough徹底地ranti-infective medication抗感染藥物occurrence kr()ns發(fā)生tibial tbl脛骨的；tibiatb脛骨talustels距骨soft tissue degloving 軟組織撕裂lower limb fractures 下肢骨折degloving套袖狀撕裂metaphyseal干骺端的 artic

7、ular depression關(guān)節(jié)壓縮weight bearing area負(fù)重區(qū)implant內(nèi)植物approach方法correspondence n. 通信；一致；相當(dāng)DOI：數(shù)字對象唯一標(biāo)識符bilaterallybailtrli雙邊地malleolusmlils踝clinic臨床；診所motor 發(fā)動(dòng)機(jī)vehicle vikl（車輛）accidentOpen fractures comprises about 10% to 30% of all pilon fractures3. These fractures are often associated with significan

8、t soft tissue degloving, metaphyseal bone defects and articular depression.IntroductionPilon fracture constitutes 1% of all lower limb fractures and about 3% to 10% of tibial fractures1,2. It is usually the result of high energy injury to the weight bearing area of the lower end of the tibia by the

9、talus. Conclusion: It is important to perform appropriate surgeries for open pilon fracture according to fracture classification, different damage to skin and tissue and time interval after injury. Key words: Delayed operation; External fixators; Fractures open; Internal fixators In spite of improve

10、ments in surgical approaches and implants, treatment of tibial pilon fractures remains challenging4. In the present study, we discuss the methods,timing and clinical outcomes of surgical treatment for open pilon fractures.Address f or correspondence Xian-tie Zeng, MD, Department of Trauma, Tianjin H

11、ospital, Tianjin, China 300211 Tel: 0086 Fax: 0086 022 24151288; Email: Received: 19 July 2010; accepted 5 October 2010DOI: 10.1111/j.1757-7861.2010.00113.xMaterials and MethodsPatient dataFrom April 2003 to July 2008, 28 patients with open tibial pilon fractures were treated in our ho

12、spital. There were 21 men and 7 women with an average age of 36.5 years (range, 1961 years). Ten patients were injured on the left side, 17 on the right and 1 bilaterally (a closed fracture of the right malleolus（踝） was not counted). The interval between injury and presentation to our clinic ranged

13、from 1 to 14 hours (average, 5.1 hours). The mechanisms of injury were high-energy falls in 10 cases,motor vehicle accidents in 12, crushing injury （擠壓傷）in 4 cases,and sports injuries in 2. The fractures were classified according to the AO/ASIF system: 7 were classified as type C1, 17 type C2, and 4

14、 type C3. Open soft tissue damage was graded according to the Gustilo system: 4 cases were classified as Gustilo I, 21 Gustilo II, 2 Gustilo IIIA, and 1 Gustilo IIIB. acetabularstbjul髖臼的fibular腓骨的;fibula腓骨femoral股骨的Calcanealklkeinil跟骨的craniocerebral ,kreiniusiri:brl顱腦的protocol方法、協(xié)議presenting with伴隨r

15、estoration恢復(fù) tibia脛骨cancellous kns()ls松質(zhì)骨insertion 插入modified改進(jìn)的cloverleaf 三葉草形Anteromedial前內(nèi)側(cè)的medial內(nèi)側(cè)的posterolateral后外側(cè)的lateral外側(cè)的constraint約束、限制 keeping in mind牢記anteroposterior前后的；正位（影像）Combined injuries included fibular fractures in 25 cases, spinal fractures in 2, upper-arm fractures in 2, rib

16、 fractures in 2, femoral fracture in 1,acetabular fracture in 1, calcaneal fracture in 1, and craniocerebral trauma in 1.demonstrating 顯示 Calcaneus（口Ki尼爾斯）：跟骨metatarsal 跖骨的ankle mortise踝關(guān)節(jié)Kirschner克氏pin克氏針Me t h o d sOne of three different surgical protocols was performed in all patients, the choice

17、 being based on the condition of soft tissue, type of fracture and length of interval between injury and presentation for treatment.D e b r i d e m e n t , o p e n reduction and internal fix at ion (ORIF)This method was applied in type C1 fractures presenting with low-grade soft tissue injury (Gusti

18、lo I, II) and interval between injury and presentation for treatment of less than 6 hours. Seven patients (four type C1 Gustilo I and three type C1 Gustilo II) were treated by this method. Surgical treatment of the pilon fractures was in four steps: (a) restoration of the correct length and stabiliz

19、ation of the fibula; (b) reconstruction of the articular surface of the tibia; (c) insertion of cancellous autografts; and (d) stabilization of the medial aspect of the tibia with the use of a modified cloverleaf plate. An anteromedial incision was employed to treat the tibial component and a latera

20、l or posterolateral incision to treat the fibular fracture. The surgical incisions were planned based on the requirements of the fracture pattern, keeping in mind the soft-tissue constraints of the individual injury. Skin closure was achieved with no tension. The tibial incisions were closed first.

21、If necessary, the fibular incisions were left for delayed closure.One of the seven patients achieved primary closure of the medial incision, followed by delayed closure of the lateral one. A typical case is shown in Fig. 1.Figure 1 A 49 year-old man with a low-energy open pilon fracture (Gustilo I &

22、 C1) (a) Photograph showing open soft tissue injury (GustiloI). (b) Preoperative anteroposterior and lateral radiographs showing Pilon fracture of type C1. (c) Postoperative radiographs showing the fractures have been anatomically reduced and fixed with plates. (d) Anteroposterior and lateral radiog

23、raphs demonstrating fractures have healed 1 year after surgery.Figure 2 A 22 year-old man with a high-energy open pilon fracture (Gustilo II & C2) (a) Photograph showing open soft tissue injury (GustiloII). (b) Preoperative radiographs showing Pilon fracture of type C2. (c) Postoperative radiographs

24、 showing the fractures have been anatomically reduced and fixed with external fixation, and the tibial fracture fixed with limited internal fixation. (d) Anteroposterior and lateral radiographs demonstrating the fractures have healed 1.5 year after surgery.D e b r i d e m e n t , l i m i t e d O R I

25、 F a n d e x t e r n a l fi x a t i o nThis method was applied in type C2 and type C3 fractures presenting with high-grade soft tissue injury (Gustilo II, III) and interval between injury and presentation for treatment of less than 8 hours. Nineteen patients (16 type C2 Gustilo II, 1 type C2 Gustilo

26、 IIIA,and 2 type C3 Gustilo II) were treated by this method.The patients were managed by immediate（直接的） debridement of the wound. Fibular fractures were always internally fixed, either with a 1/3 tubular（管狀的） plate or 3.5 mm compression plate. External fixation was applied across the ankle joint wit

27、h pins in the calcaneus, metatarsal bone, and tibia, reconstruction of the ankle mortise（踝關(guān)節(jié)）, and stabilization with screws or Kirschner pins.split-thickness skin grafting厚皮瓣轉(zhuǎn)移splint夾板e(cuò)dema（水腫） antibiotic（抗生素）extent（范圍）contamination（污染）The affected extremity （下肢）elevate抬高；提高subtalar （距下）proscribe（禁

28、止）supervise（指導(dǎo)）physical therapy program （康復(fù)鍛煉）Roll-A-Bout walker（助行器）outpatients(門診就診)Staphylococcus epidermidis（表皮葡萄球菌） Acinetobacter baumannii （鮑氏不動(dòng)桿菌）Five of the 19 patients required bone grafting because of large defects of metaphyseal bone. One case underwent delayed closure of the lateral inci

29、sion, and delayed split-thickness skin grafting was applied in another case. A typical case is shown in Fig. 2.posttraumatic arthritis.（創(chuàng)傷后關(guān)節(jié)炎） ankle-hind（后踝）D e b r i d e m e n t a n d calcane al traction ,delayed surgeryThis method was applied in type C3 fractures accompanied by high-grade soft ti

30、ssue injury (Gustilo III) and interval between injury and presentation for treatment of more than 8 hours. In two patients (one type C3 Gustilo IIIA, one type C3 Gustilo IIIB), the surgeon chose a two stage procedure（步驟）. The patients were put on calcaneal pin skeletal traction with elevation of the

31、 lower limb over a BohlerBraun splint（勃朗支架）, and measures were taken to avoid edema（水腫）. Wound drainage（引流管） was removed when there was no further evidence of infection, and a second stage operation was performed when the edema had almost completely resolved.The patients were treated with limited OR

32、IF and external fixation. The time interval between the two surgeries was 15 and 19 days, respectively. A typical case is shown in Fig. 3Figure 3 A 37 year-old man with a super high-energy open pilon fracture (Gustilo IIIB &C3) (a) Photograph showing open soft tissue injury(Gustilo IIIB) (b) Preoper

33、ative radiographs showing Pilon fracture of type C3. (c) Postoperative radiographs showing the fractures have been anatomically reduced and fixed with external fixation, the tibial fixed with limited internal fixation, and the fibula with a plate.(d) Anteroposterior and lateral radiographs demonstra

34、ting the fractures have healed 1.5 year after surgery.Postoperative careAppropriate cultures （培養(yǎng)）were obtained during surgery, and broad-spectrum antibiotics（廣譜抗生素） were administered.（執(zhí)行，使用） The choice of antibiotic（抗生素）was based on the extent（范圍）and degree of contamination（污染）. Active ankle and sub

35、talar （距下）joint range-of-motion exercises were begun as soon as the wound was dry, usually between 2 and 5 days after surgery.Weight-bearing exercise was proscribed（禁止） in the first 12 weeks after surgery. A supervised（指導(dǎo)） physical therapy program （康復(fù)鍛煉）encouraging active ankle range-of-motion exerc

36、ises was employed for the first 6 weeks. This was progressed to include passive exercises between 6 and 12 weeks. A Roll-A-Bout walker（助行器） was used when necessary.The affected extremity （下肢）was elevated （提高）continuously for the first 48 hours and then, as much as possible, for the next 7 days. proc

37、edure（步驟）broad-spectrum antibiotics（廣譜抗生素）extremity手足outpatients(門診就診)medial （內(nèi)側(cè)）originally (最初）dissection（解剖，切開） stripping （剝離）posttraumatic arthritis.（創(chuàng)傷后關(guān)節(jié)炎）ankle-hind（后踝） originally (最初)dissection（解剖，切開）stripping （剝離）ligamentotaxis （韌帶修復(fù)術(shù)）neutralization（中和）in regard to （關(guān)于）Radiographs were obtai

38、ned and evaluated according to the Burwell Charnley system: anatomic reduction was achieved in 12 cases, functional reduction in 15 cases, and poor reduction in 1 case. The healing time of the fracture was from 2.5 to 11 months, with an average of 4.7 months.Results All 28 patients were followed up

39、from 6 to 48 months with an average of 24 months, and underwent clinical and radiological examination as outpatients(門診就診). Delayed union was found in two cases; in both it was associated with bone defects of the medial （內(nèi)側(cè)）tibia. One stage wound closure was performed in 18 patients, two underwent d

40、elayed closure of their lateral incisions, and one underwent delayed split-thickness skin grafting. There were four cases of superficial sloughing of the skin. Two patients developed surface infection with Staphylococcus epidermidis（表皮葡萄球菌） and Acinetobacter baumannii （鮑氏不動(dòng)桿菌）and one developed deep

41、infection with Acinetobacter baumannii; the infection rate was 10.7% (3/28). Ten patients (35.7%) showed evidence of posttraumatic arthritis.（創(chuàng)傷后關(guān)節(jié)炎） According to the AOFAS ankle-hind（后踝） foot function evaluation（評估）, the average score was 85.2 (range, 66 to 98): excellent in 8 patients, good in 14,

42、 fair in 5, and poor in 1.DiscussionChoice of surgical methodsIn patients with type C1 fracture and Gustilo I soft tissue injury due to low-energy forces, pilon fracture was anatomically reduced and treated with debridement andinternal plate fixation following AO/ASIF principles.Open reduction and i

43、nternal fixation were originally (最初)used,but it is now known that open reduction increases the risk of complications after high-energy trauma. This is probably related to the amount of dissection（解剖，切開） and stripping （剝離）of soft tissues which is needed to achieve reduction and plate fixation. There

44、fore, when performing ORIF procedures,the surgeons tried to limit soft tissue damage and choose suitable internal fixation. The tibia was reduced with a cloverleaf plate, dynamic compression plate or locking compression plate, depending on the level of the fracture and degree of stability required.

45、Lin et al. reported an 83.3% good rate in 30 cases treated with ORIF followed up for 17 39 months5. Kalenderer et al. also reported a similar result6.External fixation and limited internal fixation were performed in all patients with type C2 and type C3 fractures presenting with high-grade soft tiss

46、ue injury (Gustilo II and III) and interval between injury and presentation at the authors clinic of less than 8 hours. Use of external fixation during the surgical procedure enables （使能夠）the surgeon to assess（評估） the length and helps stabilize the limb（肢） for reconstruction of the intra-articular（關(guān)

47、節(jié)內(nèi)） component. Placement （放置）of the external fixator with a calcaneal pin and a half-pin in the tibia allows ligamentotaxis （韌帶修復(fù)術(shù)）to occur through traction on the calcaneal pin. initial(首先)distraction（牽引）eliminate（清除）compromise（妥協(xié)、折衷、讓步）exposure（顯露，暴露）incidence （發(fā)生率）malalignment(對線不良)stiffness（僵硬）

48、stfnspreclude（排除）Pre-existing（已存在）in view of（鑒于，考慮到） ischemia（缺血）skimprecarious（不確定的）prkersThis is helpful in reduction of the fracture and allows easier access to（入路） the ankle joint for joint reconstruction. Used as a neutralization（中和） device, there is no need for large plates with the associated

49、 （相關(guān)）increased risk of skin sloughing7. Minimizing（將.減到最少） internal fixation and damage to soft tissues and blood supply decreases the rate of skin sloughing and infection. We were able to correct postoperative loss of reduction（再移位） by adjusting external fixation. It is also an excellent device in

50、those severely comminuted fractures that do not allow stable fixation with the use of a plate. Several researchers have reported similar findings in regard to （關(guān)于）external fixation811.Our results lead us to recommend (建議，推薦)that Type C3 tibial pilon fractures presenting with high-grade soft tissue i

51、njury (Gustilo III) and interval between injury and presentation for treatment of more than 8 hours should be treated with a two-stage procedure.At initial(首先) presentation,an external fixator is applied. After the soft tissues have recovered, the second stage is performed. The goal of the first sta

52、ge is to re-establish the length, alignment and rotation of the extremity and provide an environment for soft-tissue recovery.The early application of a distraction（牽引） force may help to limit any secondary injury and eliminate（清除） additional soft tissue compromise（妥協(xié)、折衷、讓步） during surgical exposure

53、（顯露，暴露）12.Several reports have shown that the two-stage procedure can reduce the rate of complications such as infection, skin sloughing, and post-traumatic arthritis1315.Prevention of postoperative complications.It has been reported that the incidence （發(fā)生率）of complications,including wound problems,

54、 skin sloughing, infection,nonunion, malalignment(對線不良), joint stiffness（僵硬） and posttraumaticarthritis, is high (45.1%) in patients with severe pilon fractures16.Skin sloughing and infection are the most important early postoperative complications17. Pre-existing（已存在） severe soft tissue injury prec

55、ludes（不能） open reduction in view of（考慮到） the potential wound problems due to ischemia（缺血） or infection of the soft tissues.The precarious（不確定的） blood supply in this region of the tibia can contribute to（有助于） the problems of both nonunion and infection18.Intensive（加強(qiáng)的）outweigh（勝過，強(qiáng)過） lateral column (

56、外側(cè)柱) ligament （韌帶）taxis（整復(fù)）circular frames（圓形框架） hybrid systems（混合系統(tǒng)）habrdhinge axis （鉸鏈軸）hndplaster cast（石膏）optimal（最佳的）manuscript（手稿，文章） In the present study, there were four cases of skin sloughing, two of superficial infections, and only one of deep bone infection. Surgical approaches are now pl

57、anned based on the requirements of the fracture pattern, keeping in mind the soft-tissue constraints of the individual injury.The incisions are kept at least 7 cm apart to prevent soft-tissue ischemia and secondary woundbreakdown. Intensive（加強(qiáng)的） debridement,minimization of softtissue stripping and p

58、roper use of antibiotics are useful for preventing infection.Delayed union, especially in the metaphyseal portion, is also a problem with pilon fractures. We noted a 7.1% delayed union rate in this series. The severity of the injury and poor blood supply to the distal tibia may outweigh（勝過，強(qiáng)過） the affects of any particular approach when it comes to nonunion or delayed union, and it is also probably caused by tibial bone defect after fixation of the fibula. But there is not decided for the fibula fixation19,20.We think that fibular fracture should