Pilon骨折的外科治療英文加翻譯

Received:19July2010;accepted5October2010

DOI:10.1111/j.1757-7861.2010.00113.x

目前十六頁\總數(shù)一百零八頁\編于十五點MaterialsandMethods

Patientdata

FromApril2003toJuly2008,28patientswithopentibialpilonfracturesweretreatedinourhospital.

目前十七頁\總數(shù)一百零八頁\編于十五點Therewere21menand7womenwithanaverageageof36.5years(range,19–61years).Tenpatientswereinjuredontheleftside,17ontherightand1bilaterally(aclosedfractureoftherightmalleolus（踝）wasnotcounted).目前十八頁\總數(shù)一百零八頁\編于十五點Theintervalbetweeninjuryandpresentationtoourclinicrangedfrom1to14hours(average,5.1hours).Themechanismsofinjurywerehigh-energyfallsin10cases,motorvehicleaccidentsin12,crushinginjury（擠壓傷）in4cases,andsportsinjuriesin2.

目前十九頁\總數(shù)一百零八頁\編于十五點ThefractureswereclassifiedaccordingtotheAO/ASIFsystem:7wereclassifiedastypeC1,17typeC2,and4typeC3.

目前二十頁\總數(shù)一百零八頁\編于十五點OpensofttissuedamagewasgradedaccordingtotheGustilosystem:4caseswereclassifiedasGustiloI,21GustiloII,2GustiloIIIA,and1GustiloIIIB.

目前二十一頁\總數(shù)一百零八頁\編于十五點acetabular?s?'t?bjul?]髖臼的fibular腓骨的;fibula腓骨femoral股骨的Calcaneal[k?l'keini?l跟骨的craniocerebral[,kreini?usi'ri:br?l顱腦的protocol方法、協(xié)議presentingwith伴隨restoration恢復(fù)

tibia脛骨目前二十二頁\總數(shù)一百零八頁\編于十五點cancellous

['k?ns(?)l?s]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

keepinginmind牢記anteroposterior前后的；正位（影像）目前二十三頁\總數(shù)一百零八頁\編于十五點Combinedinjuriesincludedfibularfracturesin25cases,spinalfracturesin2,upper-armfracturesin2,ribfracturesin2,femoralfracturein1,acetabularfracturein1,calcanealfracturein1,andcraniocerebraltraumain1.

目前二十四頁\總數(shù)一百零八頁\編于十五點demonstrating顯示

Calcaneus（口Ki尼爾斯）：跟骨metatarsal跖骨的anklemortise踝關(guān)節(jié)Kirschner克氏pin克氏針目前二十五頁\總數(shù)一百零八頁\編于十五點Methods

Oneofthreedifferentsurgicalprotocolswasperformedinallpatients,thechoicebeingbasedontheconditionofsofttissue,typeoffractureandlengthofintervalbetweeninjuryandpresentationfortreatment.

目前二十六頁\總數(shù)一百零八頁\編于十五點Debridement,openreductionandinternalfixation(ORIF)

ThismethodwasappliedintypeC1fracturespresentingwithlow-gradesofttissueinjury(GustiloI,II)andintervalbetweeninjuryandpresentationfortreatmentoflessthan6hours.

目前二十七頁\總數(shù)一百零八頁\編于十五點Sevenpatients(fourtypeC1GustiloIandthreetypeC1GustiloII)weretreatedbythismethod.

目前二十八頁\總數(shù)一百零八頁\編于十五點Surgicaltreatmentofthepilonfractureswasinfoursteps:(a)restorationofthecorrectlengthand

stabilizationofthefibula;目前二十九頁\總數(shù)一百零八頁\編于十五點

(b)reconstructionofthearticularsurfaceofthetibia;(c)insertionofcancellousautografts;and(d)stabilizationofthemedialaspectofthetibiawiththeuseofamodifiedcloverleafplate.

目前三十頁\總數(shù)一百零八頁\編于十五點Ananteromedialincisionwasemployedtotreatthetibialcomponentandalateralorposterolateralincisiontotreatthefibularfracture.

目前三十一頁\總數(shù)一百零八頁\編于十五點Thesurgicalincisionswereplannedbasedontherequirementsofthefracturepattern,keepinginmindthesoft-tissueconstraintsoftheindividualinjury.目前三十二頁\總數(shù)一百零八頁\編于十五點Skinclosurewasachievedwithnotension.Thetibialincisionswereclosedfirst.Ifnecessary,thefibularincisionswereleftfordelayedclosure.

目前三十三頁\總數(shù)一百零八頁\編于十五點Oneofthesevenpatientsachievedprimaryclosureofthemedialincision,followedbydelayedclosureofthelateralone.AtypicalcaseisshowninFig.1.目前三十四頁\總數(shù)一百零八頁\編于十五點Figure1A49year-oldmanwithalow-energyopenpilonfracture(GustiloI&C1)(a)Photographshowingopensofttissueinjury(GustiloI).(b)PreoperativeanteroposteriorandlateralradiographsshowingPilonfractureoftypeC1.(c)Postoperativeradiographsshowingthefractureshavebeenanatomicallyreducedandfixedwithplates.(d)Anteroposteriorandlateralradiographsdemonstratingfractureshavehealed1yearaftersurgery.

目前三十五頁\總數(shù)一百零八頁\編于十五點目前三十六頁\總數(shù)一百零八頁\編于十五點Figure2A22year-oldmanwithahigh-energyopenpilonfracture(GustiloII&C2)(a)Photographshowingopensofttissueinjury(GustiloII).(b)PreoperativeradiographsshowingPilonfractureoftypeC2.

目前三十七頁\總數(shù)一百零八頁\編于十五點(c)Postoperativeradiographsshowingthefractureshavebeenanatomicallyreducedandfixedwithexternalfixation,andthetibialfracturefixedwithlimitedinternalfixation.(d)Anteroposteriorandlateralradiographs

demonstratingthefractureshavehealed1.5yearaftersurgery.

目前三十八頁\總數(shù)一百零八頁\編于十五點Debridement,limitedORIFandexternalfixation

ThismethodwasappliedintypeC2andtypeC3fracturespresentingwithhigh-gradesofttissueinjury(GustiloII,III)andintervalbetweeninjuryandpresentationfortreatmentoflessthan8hours.

目前三十九頁\總數(shù)一百零八頁\編于十五點Nineteenpatients(16typeC2GustiloII,1typeC2GustiloIIIA,and2typeC3GustiloII)weretreatedbythismethod.

目前四十頁\總數(shù)一百零八頁\編于十五點Thepatientsweremanagedbyimmediate（直接的）debridementofthewound.Fibularfractureswerealwaysinternallyfixed,eitherwitha1/3tubular（管狀的）plateor3.5mmcompressionplate.

目前四十一頁\總數(shù)一百零八頁\編于十五點Externalfixationwasappliedacrosstheankle

jointwithpinsinthecalcaneus,metatarsalbone,andtibia,reconstructionoftheanklemortise（踝關(guān)節(jié)）,andstabilizationwithscrewsorKirschnerpins.

目前四十二頁\總數(shù)一百零八頁\編于十五點split-thicknessskingrafting厚皮瓣轉(zhuǎn)移splint夾板edema（水腫）

antibiotic（抗生素）extent（范圍）contamination（污染）Theaffectedextremity（下肢）elevate抬高；提高subtalar（距下）目前四十三頁\總數(shù)一百零八頁\編于十五點proscribe（禁止）supervise（指導(dǎo)）physicaltherapy

program（康復(fù)鍛煉）Roll-A-Boutwalker（助行器）outpatients(門診就診)Staphylococcus

epidermidis（表皮葡萄球菌）Acinetobacterbaumannii（鮑氏不動桿菌）目前四十四頁\總數(shù)一百零八頁\編于十五點Fiveofthe19patientsrequiredbonegraftingbecauseoflargedefectsofmetaphysealbone.Onecaseunderwentdelayedclosureofthelateralincision,anddelayedsplit-thicknessskingraftingwasappliedinanothercase.AtypicalcaseisshowninFig.2.

目前四十五頁\總數(shù)一百零八頁\編于十五點posttraumaticarthritis.（創(chuàng)傷后關(guān)節(jié)炎）ankle-hind（后踝）目前四十六頁\總數(shù)一百零八頁\編于十五點Debridement

and

calcaneal

traction,delayedsurgeryThismethodwasappliedintypeC3fracturesaccompaniedbyhigh-gradesofttissueinjury(GustiloIII)and

intervalbetweeninjuryandpresentationfortreatmentof

morethan8hours.目前四十七頁\總數(shù)一百零八頁\編于十五點Intwopatients(onetypeC3Gustilo

IIIA,onetypeC3GustiloIIIB),thesurgeonchoseatwo

stageprocedure（步驟）.目前四十八頁\總數(shù)一百零八頁\編于十五點Thepatientswereputoncalcanealpin

skeletaltractionwithelevationofthelowerlimbovera

Bohler–Braunsplint（勃朗支架）,andmeasuresweretakentoavoid

edema（水腫）.目前四十九頁\總數(shù)一百零八頁\編于十五點Wounddrainage（引流管）wasremovedwhentherewasno

furtherevidenceofinfection,andasecondstageoperationwasperformedwhentheedemahadalmostcompletelyresolved.目前五十頁\總數(shù)一百零八頁\編于十五點ThepatientsweretreatedwithlimitedORIFandexternalfixation.Thetimeintervalbetweenthetwosurgerieswas15and19days,respectively.Atypical

caseisshowninFig.3目前五十一頁\總數(shù)一百零八頁\編于十五點目前五十二頁\總數(shù)一百零八頁\編于十五點Figure3A37year-oldmanwithasuperhigh-energyopenpilonfracture(GustiloIIIB&C3)(a)Photographshowingopensofttissueinjury(GustiloIIIB)(b)PreoperativeradiographsshowingPilonfractureoftypeC3.目前五十三頁\總數(shù)一百零八頁\編于十五點(c)Postoperativeradiographsshowingthefractureshave

beenanatomicallyreducedandfixedwithexternalfixation,thetibialfixedwithlimitedinternalfixation,andthefibulawithaplate.(d)Anteroposteriorandlateralradiographsdemonstratingthefractureshavehealed1.5yearaftersurgery.目前五十四頁\總數(shù)一百零八頁\編于十五點PostoperativecareAppropriatecultures（培養(yǎng)）wereobtainedduringsurgery,and

broad-spectrumantibiotics（廣譜抗生素）wereadministered.（執(zhí)行，使用）The

choiceofantibiotic（抗生素）wasbasedontheextent（范圍）anddegreeof

contamination（污染）.

目前五十五頁\總數(shù)一百零八頁\編于十五點Activeankleandsubtalar（距下）jointrange-of-motionexerciseswerebegunassoonasthe

woundwasdry,usuallybetween2and5daysaftersurgery.Weight-bearingexercisewasproscribed（禁止）inthefirst12

weeksaftersurgery.目前五十六頁\總數(shù)一百零八頁\編于十五點Asupervised（指導(dǎo)）physicaltherapy

program（康復(fù)鍛煉）encouragingactiveanklerange-of-motionexerciseswasemployedforthefirst6weeks.Thiswasprogressedtoincludepassiveexercisesbetween6and12

weeks.ARoll-A-Boutwalker（助行器）wasusedwhennecessary.目前五十七頁\總數(shù)一百零八頁\編于十五點Theaffectedextremity（下肢）waselevated（提高）continuouslyforthefirst48hoursandthen,asmuchas

possible,forthenext7days.目前五十八頁\總數(shù)一百零八頁\編于十五點procedure（步驟）broad-spectrumantibiotics（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）目前五十九頁\總數(shù)一百零八頁\編于十五點posttraumaticarthritis.（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

regardto（關(guān)于）目前六十頁\總數(shù)一百零八頁\編于十五點Radiographs

wereobtainedandevaluatedaccordingtotheBurwell

Charnleysystem:anatomicreductionwasachieved

in12cases,functionalreductionin15cases,andpoorreductionin1case.目前六十一頁\總數(shù)一百零八頁\編于十五點Thehealingtimeofthefracturewasfrom2.5to11months,withanaverageof4.7months.目前六十二頁\總數(shù)一百零八頁\編于十五點Results

All28patientswerefollowedupfrom6to48months

withanaverageof24months,andunderwentclinicaland

radiologicalexaminationasoutpatients(門診就診).目前六十三頁\總數(shù)一百零八頁\編于十五點Delayedunionwasfoundintwocases;inbothitwas

associatedwithbonedefectsofthemedial（內(nèi)側(cè)）tibia.Onestage

woundclosurewasperformedin18patients,twounderwentdelayedclosureoftheirlateralincisions,andone

underwentdelayedsplit-thicknessskingrafting.目前六十四頁\總數(shù)一百零八頁\編于十五點There

werefourcasesofsuperficialsloughingoftheskin.Two

patientsdevelopedsurfaceinfectionwithStaphylococcus

epidermidis（表皮葡萄球菌）andAcinetobacterbaumannii（鮑氏不動桿菌）andonedevelopeddeepinfectionwithAcinetobacterbaumannii;the

infectionratewas10.7%(3/28).目前六十五頁\總數(shù)一百零八頁\編于十五點Tenpatients(35.7%)

showedevidenceofposttraumaticarthritis.（創(chuàng)傷后關(guān)節(jié)炎）Accordingto

theAOFASankle-hind（后踝）footfunctionevaluation（評估）,the

averagescorewas85.2(range,66to98):excellentin8

patients,goodin14,fairin5,andpoorin1.目前六十六頁\總數(shù)一百零八頁\編于十五點DiscussionChoiceofsurgicalmethodsInpatientswithtypeC1fractureandGustiloIsoft

tissueinjuryduetolow-energyforces,pilonfracturewas

anatomicallyreducedandtreatedwithdebridementandinternalplatefixationfollowingAO/ASIFprinciples.目前六十七頁\總數(shù)一百零八頁\編于十五點Openreductionandinternalfixationwereoriginally(最初)used,butitisnowknownthatopenreductionincreasestherisk

ofcomplicationsafterhigh-energytrauma.目前六十八頁\總數(shù)一百零八頁\編于十五點Thisisprobablyrelatedtotheamountofdissection（解剖，切開）andstripping（剝離）of

softtissueswhichisneededtoachievereductionandplate

fixation.目前六十九頁\總數(shù)一百零八頁\編于十五點Therefore,whenperformingORIFprocedures,thesurgeonstriedtolimitsofttissuedamageandchoose

suitableinternalfixation.目前七十頁\總數(shù)一百零八頁\編于十五點Thetibiawasreducedwitha

cloverleafplate,dynamiccompressionplateorlocking

compressionplate,dependingonthelevelofthefracture

anddegreeofstabilityrequired.目前七十一頁\總數(shù)一百零八頁\編于十五點Linetal.reportedan

83.3%goodratein30casestreatedwithORIFfollowed

upfor17~39months5.Kalendereretal.alsoreporteda

similarresult6.目前七十二頁\總數(shù)一百零八頁\編于十五點ExternalfixationandlimitedinternalfixationwereperformedinallpatientswithtypeC2andtypeC3fractures

presentingwithhigh-gradesofttissueinjury(GustiloII

andIII)andintervalbetweeninjuryandpresentationat

theauthors’clinicoflessthan8hours.

目前七十三頁\總數(shù)一百零八頁\編于十五點Useofexternal

fixationduringthesurgicalprocedureenables（使能夠）thesurgeon

toassess（評估）thelengthandhelpsstabilizethelimb（肢）forreconstructionoftheintra-articular（關(guān)節(jié)內(nèi)）component.目前七十四頁\總數(shù)一百零八頁\編于十五點Placement（放置）of

theexternalfixatorwithacalcanealpinandahalf-pinin

thetibiaallowsligamentotaxis（韌帶修復(fù)術(shù)）tooccurthroughtraction

onthecalcanealpin.目前七十五頁\總數(shù)一百零八頁\編于十五點目前七十六頁\總數(shù)一百零八頁\編于十五點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）['st?fn?s]目前七十七頁\總數(shù)一百零八頁\編于十五點preclude（排除）Pre-existing（已存在）inviewof（鑒于，考慮到）

ischemia（缺血）[?s'kim??]precarious（不確定的）[pr?'ke?r??s]目前七十八頁\總數(shù)一百零八頁\編于十五點Thisishelpfulinreductionofthe

fractureandallowseasieraccessto（入路）theanklejointfor

joint

reconstruction.目前七十九頁\總數(shù)一百零八頁\編于十五點Usedasaneutralization（中和）device,thereisno

needforlargeplateswiththeassociated（相關(guān)）increasedriskof

skinsloughing7.目前八十頁\總數(shù)一百零八頁\編于十五點Minimizing（將...減到最少）internalfixationanddamage

tosofttissuesandbloodsupplydecreasestherateofskin

sloughingandinfection.目前八十一頁\總數(shù)一百零八頁\編于十五點Wewereabletocorrectpostoperativelossofreduction（再移位）byadjustingexternalfixation.It

isalsoanexcellentdeviceinthoseseverelycomminuted

fracturesthatdonotallowstablefixationwiththeuseofa

plate.目前八十二頁\總數(shù)一百零八頁\編于十五點Severalresearchershavereportedsimilarfindingsin

regardto（關(guān)于）externalfixation8–11.目前八十三頁\總數(shù)一百零八頁\編于十五點Ourresultsleadustorecommend(建議，推薦)thatTypeC3tibial

pilonfracturespresentingwithhigh-gradesofttissue

injury(GustiloIII)andintervalbetweeninjuryandpresentation

fortreatmentofmorethan8hoursshouldbe

treatedwithatwo-stageprocedure.目前八十四頁\總數(shù)一百零八頁\編于十五點Atinitial(首先)presentation,anexternalfixatorisapplied.Afterthesofttissueshave

recovered,thesecondstageisperformed.目前八十五頁\總數(shù)一百零八頁\編于十五點Thegoalofthe

firststageistore-establishthelength,alignmentandrotation

oftheextremityandprovideanenvironmentfor

soft-tissuerecovery.目前八十六頁\總數(shù)一百零八頁\編于十五點Theearlyapplicationofadistraction（牽引）forcemayhelptolimitanysecondaryinjuryandeliminate（清除）additionalsofttissuecompromise（妥協(xié)、折衷、讓步）duringsurgicalexposure（顯露，暴露）12.目前八十七頁\總數(shù)一百零八頁\編于十五點Severalreportshaveshownthatthetwo-stageprocedure

canreducetherateofcomplicationssuchas

infection,skinsloughing,andpost-traumaticarthritis13–15.目前八十八頁\總數(shù)一百零八頁\編于十五點Preventionofpostoperativecomplications.Ithasbeenreportedthattheincidence（發(fā)生率）ofcomplications,includingwoundproblems,skinsloughing,infection,nonunion,malalignment(對線不良),jointstiffness（僵硬）andposttraumaticarthritis,ishigh(45.1%)inpatientswithsevere

pilonfractures16.目前八十九頁\總數(shù)一百零八頁\編于十五點Skinsloughingandinfectionarethemostimportant

earlypostoperativecomplications17.Pre-existing（已存在）severe

softtissueinjuryprecludes（不能）openreductioninviewof（考慮到）the

potentialwoundproblemsduetoischemia（缺血）orinfectionof

thesofttissues.目前九十頁\總數(shù)一百零八頁\編于十五點Theprecarious（不確定的）bloodsupplyinthisregion

ofthetibiacancontributeto（有助于）theproblemsofbothnonunion

andinfection18.目前九十一頁\總數(shù)一百零八頁\編于十五點Intensive（加強(qiáng)的）outweigh（勝過，強(qiáng)過）

lateralcolumn(外側(cè)柱)ligament（韌帶）taxis（整復(fù)）circularframes（圓形框架）

hybridsystems（混合系統(tǒng)）['ha?br?d]目前九十二頁\總數(shù)一百零八頁\編于十五點hingeaxis（鉸鏈軸）[h?nd?]plastercast（石膏）optimal（最佳的）manuscript（手稿，文章）目前九十三頁\總數(shù)一百零八頁\編于十五點Inthepresentstudy,therewerefour

casesofskinsloughing,twoofsuperficialinfections,and

onlyoneofdeepboneinfection.目前九十四頁\總數(shù)一百零八頁\編于十五點Surgicalapproachesare

nowplannedbasedonthe

requirementsofthefracture

pattern,keepinginmindthesoft-tissueconstraintsofthe

individualinjury.目前九十五頁\總數(shù)一百零八頁\編于十五點Theincisionsarekeptatleast7cmapart

topreventsoft-tissueischemiaandsecondarywoundbreakdown.目前九十六頁\總數(shù)一百零八頁\編于十五點Intensive（加強(qiáng)的）debridement,minimizationofsofttissuestrippingandproperuseofantibioticsareusefulfor

preventinginfection.目前九十七頁\總數(shù)一百零八頁\編于十五點Delayedunion,especiallyinthemetaphysealportion,is

alsoaproblemwithpilonfractures.Wenoteda7.1%

delayedunionrateinthisseries.目前九十八頁\總數(shù)一百零八頁\編于十五點Theseverityoftheinjury

andpoorbloodsupplytothedistaltibiamayoutweigh（勝過，強(qiáng)過）the

affectsofanyparticularapproachwhenitcomestononunionordelayedunion,anditisalsoprobablycausedby

tibialbonedefectafterfixationofthefibula.Butthereis

notdecidedforthefibulafixation19,20.目前九十九頁\總數(shù)一百零八頁\編于十五點Wethinktha