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

現(xiàn)在是16頁\一共有108頁\編輯于星期一MaterialsandMethods

Patientdata

FromApril2003toJuly2008,28patientswithopentibialpilonfracturesweretreatedinourhospital.

現(xiàn)在是17頁\一共有108頁\編輯于星期一Therewere21menand7womenwithanaverageageof36.5years(range,19–61years).Tenpatientswereinjuredontheleftside,17ontherightand1bilaterally(aclosedfractureoftherightmalleolus（踝）wasnotcounted).現(xiàn)在是18頁\一共有108頁\編輯于星期一Theintervalbetweeninjuryandpresentationtoourclinicrangedfrom1to14hours(average,5.1hours).Themechanismsofinjurywerehigh-energyfallsin10cases,motorvehicleaccidentsin12,crushinginjury（擠壓傷）in4cases,andsportsinjuriesin2.

現(xiàn)在是19頁\一共有108頁\編輯于星期一ThefractureswereclassifiedaccordingtotheAO/ASIFsystem:7wereclassifiedastypeC1,17typeC2,and4typeC3.

現(xiàn)在是20頁\一共有108頁\編輯于星期一OpensofttissuedamagewasgradedaccordingtotheGustilosystem:4caseswereclassifiedasGustiloI,21GustiloII,2GustiloIIIA,and1GustiloIIIB.

現(xiàn)在是21頁\一共有108頁\編輯于星期一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脛骨現(xiàn)在是22頁\一共有108頁\編輯于星期一cancellous

['k?ns(?)l?s]松質(zhì)骨insertion插入modified改進的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）現(xiàn)在是23頁\一共有108頁\編輯于星期一Combinedinjuriesincludedfibularfracturesin25cases,spinalfracturesin2,upper-armfracturesin2,ribfracturesin2,femoralfracturein1,acetabularfracturein1,calcanealfracturein1,andcraniocerebraltraumain1.

現(xiàn)在是24頁\一共有108頁\編輯于星期一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克氏針現(xiàn)在是25頁\一共有108頁\編輯于星期一Methods

Oneofthreedifferentsurgicalprotocolswasperformedinallpatients,thechoicebeingbasedontheconditionofsofttissue,typeoffractureandlengthofintervalbetweeninjuryandpresentationfortreatment.

現(xiàn)在是26頁\一共有108頁\編輯于星期一Debridement,openreductionandinternalfixation(ORIF)

ThismethodwasappliedintypeC1fracturespresentingwithlow-gradesofttissueinjury(GustiloI,II)andintervalbetweeninjuryandpresentationfortreatmentoflessthan6hours.

現(xiàn)在是27頁\一共有108頁\編輯于星期一Sevenpatients(fourtypeC1GustiloIandthreetypeC1GustiloII)weretreatedbythismethod.

現(xiàn)在是28頁\一共有108頁\編輯于星期一Surgicaltreatmentofthepilonfractureswasinfoursteps:(a)restorationofthecorrectlengthand

stabilizationofthefibula;現(xiàn)在是29頁\一共有108頁\編輯于星期一

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

現(xiàn)在是30頁\一共有108頁\編輯于星期一Ananteromedialincisionwasemployedtotreatthetibialcomponentandalateralorposterolateralincisiontotreatthefibularfracture.

現(xiàn)在是31頁\一共有108頁\編輯于星期一Thesurgicalincisionswereplannedbasedontherequirementsofthefracturepattern,keepinginmindthesoft-tissueconstraintsoftheindividualinjury.現(xiàn)在是32頁\一共有108頁\編輯于星期一Skinclosurewasachievedwithnotension.Thetibialincisionswereclosedfirst.Ifnecessary,thefibularincisionswereleftfordelayedclosure.

現(xiàn)在是33頁\一共有108頁\編輯于星期一Oneofthesevenpatientsachievedprimaryclosureofthemedialincision,followedbydelayedclosureofthelateralone.AtypicalcaseisshowninFig.1.現(xiàn)在是34頁\一共有108頁\編輯于星期一Figure1

A49year-oldmanwithalow-energyopenpilonfracture(GustiloI&C1)(a)Photographshowingopensofttissueinjury(GustiloI).(b)PreoperativeanteroposteriorandlateralradiographsshowingPilonfractureoftypeC1.(c)Postoperativeradiographsshowingthefractureshavebeenanatomicallyreducedandfixedwithplates.(d)Anteroposteriorandlateralradiographsdemonstratingfractureshavehealed1yearaftersurgery.

現(xiàn)在是35頁\一共有108頁\編輯于星期一現(xiàn)在是36頁\一共有108頁\編輯于星期一Figure2A22year-oldmanwithahigh-energyopenpilonfracture(GustiloII&C2)(a)Photographshowingopensofttissueinjury(GustiloII).(b)PreoperativeradiographsshowingPilonfractureoftypeC2.

現(xiàn)在是37頁\一共有108頁\編輯于星期一(c)Postoperativeradiographsshowingthefractureshavebeenanatomicallyreducedandfixedwithexternalfixation,andthetibialfracturefixedwithlimitedinternalfixation.(d)Anteroposteriorandlateralradiographs

demonstratingthefractureshavehealed1.5yearaftersurgery.

現(xiàn)在是38頁\一共有108頁\編輯于星期一Debridement,limitedORIFandexternalfixation

ThismethodwasappliedintypeC2andtypeC3fracturespresentingwithhigh-gradesofttissueinjury(GustiloII,III)andintervalbetweeninjuryandpresentationfortreatmentoflessthan8hours.

現(xiàn)在是39頁\一共有108頁\編輯于星期一Nineteenpatients(16typeC2GustiloII,1typeC2GustiloIIIA,and2typeC3GustiloII)weretreatedbythismethod.

現(xiàn)在是40頁\一共有108頁\編輯于星期一Thepatientsweremanagedbyimmediate（直接的）debridementofthewound.Fibularfractureswerealwaysinternallyfixed,eitherwitha1/3tubular（管狀的）plateor3.5mmcompressionplate.

現(xiàn)在是41頁\一共有108頁\編輯于星期一Externalfixationwasappliedacrosstheankle

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

現(xiàn)在是42頁\一共有108頁\編輯于星期一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）現(xiàn)在是43頁\一共有108頁\編輯于星期一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）現(xiàn)在是44頁\一共有108頁\編輯于星期一Fiveofthe19patientsrequiredbonegraftingbecauseoflargedefectsofmetaphysealbone.Onecaseunderwentdelayedclosureofthelateralincision,anddelayedsplit-thicknessskingraftingwasappliedinanothercase.AtypicalcaseisshowninFig.2.

現(xiàn)在是45頁\一共有108頁\編輯于星期一posttraumaticarthritis.（創(chuàng)傷后關(guān)節(jié)炎）ankle-hind（后踝）現(xiàn)在是46頁\一共有108頁\編輯于星期一Debridement

and

calcaneal

traction,delayedsurgeryThismethodwasappliedintypeC3fracturesaccompaniedbyhigh-gradesofttissueinjury(GustiloIII)and

intervalbetweeninjuryandpresentationfortreatmentof

morethan8hours.現(xiàn)在是47頁\一共有108頁\編輯于星期一Intwopatients(onetypeC3Gustilo

IIIA,onetypeC3GustiloIIIB),thesurgeonchoseatwo

stageprocedure（步驟）.現(xiàn)在是48頁\一共有108頁\編輯于星期一Thepatientswereputoncalcanealpin

skeletaltractionwithelevationofthelowerlimbovera

Bohler–Braunsplint（勃朗支架）,andmeasuresweretakentoavoid

edema（水腫）.現(xiàn)在是49頁\一共有108頁\編輯于星期一Wounddrainage（引流管）wasremovedwhentherewasno

furtherevidenceofinfection,andasecondstageoperationwasperformedwhentheedemahadalmostcompletelyresolved.現(xiàn)在是50頁\一共有108頁\編輯于星期一ThepatientsweretreatedwithlimitedORIFandexternalfixation.Thetimeintervalbetweenthetwosurgerieswas15and19days,respectively.Atypical

caseisshowninFig.3現(xiàn)在是51頁\一共有108頁\編輯于星期一現(xiàn)在是52頁\一共有108頁\編輯于星期一Figure3A37year-oldmanwithasuperhigh-energyopenpilonfracture(GustiloIIIB&C3)(a)Photographshowingopensofttissueinjury(GustiloIIIB)(b)PreoperativeradiographsshowingPilonfractureoftypeC3.現(xiàn)在是53頁\一共有108頁\編輯于星期一(c)Postoperativeradiographsshowingthefractureshave

beenanatomicallyreducedandfixedwithexternalfixation,thetibialfixedwithlimitedinternalfixation,andthefibulawithaplate.(d)Anteroposteriorandlateralradiographsdemonstratingthefractureshavehealed1.5yearaftersurgery.現(xiàn)在是54頁\一共有108頁\編輯于星期一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）.

現(xiàn)在是55頁\一共有108頁\編輯于星期一Activeankleandsubtalar（距下）jointrange-of-motionexerciseswerebegunassoonasthe

woundwasdry,usuallybetween2and5daysaftersurgery.Weight-bearingexercisewasproscribed（禁止）inthefirst12

weeksaftersurgery.現(xiàn)在是56頁\一共有108頁\編輯于星期一Asupervised（指導(dǎo)）physicaltherapy

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

weeks.ARoll-A-Boutwalker（助行器）wasusedwhennecessary.現(xiàn)在是57頁\一共有108頁\編輯于星期一Theaffectedextremity（下肢）waselevated（提高）continuouslyforthefirst48hoursandthen,asmuchas

possible,forthenext7days.現(xiàn)在是58頁\一共有108頁\編輯于星期一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）現(xiàn)在是59頁\一共有108頁\編輯于星期一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）現(xiàn)在是60頁\一共有108頁\編輯于星期一Radiographs

wereobtainedandevaluatedaccordingtotheBurwell

Charnleysystem:anatomicreductionwasachieved

in12cases,functionalreductionin15cases,andpoorreductionin1case.現(xiàn)在是61頁\一共有108頁\編輯于星期一Thehealingtimeofthefracturewasfrom2.5to11months,withanaverageof4.7months.現(xiàn)在是62頁\一共有108頁\編輯于星期一Results

All28patientswerefollowedupfrom6to48months

withanaverageof24months,andunderwentclinicaland

radiologicalexaminationasoutpatients(門診就診).現(xiàn)在是63頁\一共有108頁\編輯于星期一Delayedunionwasfoundintwocases;inbothitwas

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

woundclosurewasperformedin18patients,twounderwentdelayedclosureoftheirlateralincisions,andone

underwentdelayedsplit-thicknessskingrafting.現(xiàn)在是64頁\一共有108頁\編輯于星期一There

werefourcasesofsuperficialsloughingoftheskin.Two

patientsdevelopedsurfaceinfectionwithStaphylococcus

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

infectionratewas10.7%(3/28).現(xiàn)在是65頁\一共有108頁\編輯于星期一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.現(xiàn)在是66頁\一共有108頁\編輯于星期一DiscussionChoiceofsurgicalmethodsInpatientswithtypeC1fractureandGustiloIsoft

tissueinjuryduetolow-energyforces,pilonfracturewas

anatomicallyreducedandtreatedwithdebridementandinternalplatefixationfollowingAO/ASIFprinciples.現(xiàn)在是67頁\一共有108頁\編輯于星期一Openreductionandinternalfixationwereoriginally(最初)used,butitisnowknownthatopenreductionincreasestherisk

ofcomplicationsafterhigh-energytrauma.現(xiàn)在是68頁\一共有108頁\編輯于星期一Thisisprobablyrelatedtotheamountofdissection（解剖，切開）andstripping（剝離）of

softtissueswhichisneededtoachievereductionandplate

fixation.現(xiàn)在是69頁\一共有108頁\編輯于星期一Therefore,whenperformingORIFprocedures,thesurgeonstriedtolimitsofttissuedamageandchoose

suitableinternalfixation.現(xiàn)在是70頁\一共有108頁\編輯于星期一Thetibiawasreducedwitha

cloverleafplate,dynamiccompressionplateorlocking

compressionplate,dependingonthelevelofthefracture

anddegreeofstabilityrequired.現(xiàn)在是71頁\一共有108頁\編輯于星期一Linetal.reportedan

83.3%goodratein30casestreatedwithORIFfollowed

upfor17~39months5.Kalendereretal.alsoreporteda

similarresult6.現(xiàn)在是72頁\一共有108頁\編輯于星期一ExternalfixationandlimitedinternalfixationwereperformedinallpatientswithtypeC2andtypeC3fractures

presentingwithhigh-gradesofttissueinjury(GustiloII

andIII)andintervalbetweeninjuryandpresentationat

theauthors’clinicoflessthan8hours.

現(xiàn)在是73頁\一共有108頁\編輯于星期一Useofexternal

fixationduringthesurgicalprocedureenables（使能夠）thesurgeon

toassess（評估）thelengthandhelpsstabilizethelimb（肢）forreconstructionoftheintra-articular（關(guān)節(jié)內(nèi)）component.現(xiàn)在是74頁\一共有108頁\編輯于星期一Placement（放置）of

theexternalfixatorwithacalcanealpinandahalf-pinin

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

onthecalcanealpin.現(xiàn)在是75頁\一共有108頁\編輯于星期一現(xiàn)在是76頁\一共有108頁\編輯于星期一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]現(xiàn)在是77頁\一共有108頁\編輯于星期一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]現(xiàn)在是78頁\一共有108頁\編輯于星期一Thisishelpfulinreductionofthe

fractureandallowseasieraccessto（入路）theanklejointfor

joint

reconstruction.現(xiàn)在是79頁\一共有108頁\編輯于星期一Usedasaneutralization（中和）device,thereisno

needforlargeplateswiththeassociated（相關(guān)）increasedriskof

skinsloughing7.現(xiàn)在是80頁\一共有108頁\編輯于星期一Minimizing（將...減到最少）internalfixationanddamage

tosofttissuesandbloodsupplydecreasestherateofskin

sloughingandinfection.現(xiàn)在是81頁\一共有108頁\編輯于星期一Wewereabletocorrectpostoperativelossofreduction（再移位）byadjustingexternalfixation.It

isalsoanexcellentdeviceinthoseseverelycomminuted

fracturesthatdonotallowstablefixationwiththeuseofa

plate.現(xiàn)在是82頁\一共有108頁\編輯于星期一Severalresearchershavereportedsimilarfindingsin

regardto（關(guān)于）externalfixation8–11.現(xiàn)在是83頁\一共有108頁\編輯于星期一Ourresultsleadustorecommend(建議，推薦)thatTypeC3tibial

pilonfracturespresentingwithhigh-gradesofttissue

injury(GustiloIII)andintervalbetweeninjuryandpresentation

fortreatmentofmorethan8hoursshouldbe

treatedwithatwo-stageprocedure.現(xiàn)在是84頁\一共有108頁\編輯于星期一Atinitial(首先)presentation,anexternalfixatorisapplied.Afterthesofttissueshave

recovered,thesecondstageisperformed.現(xiàn)在是85頁\一共有108頁\編輯于星期一Thegoalofthe

firststageistore-establishthelength,alignmentandrotation

oftheextremityandprovideanenvironmentfor

soft-tissuerecovery.現(xiàn)在是86頁\一共有108頁\編輯于星期一Theearlyapplicationofadistraction（牽引）forcemayhelptolimitanysecondaryinjuryandeliminate（清除）additionalsofttissuecompromise（妥協(xié)、折衷、讓步）duringsurgicalexposure（顯露，暴露）12.現(xiàn)在是87頁\一共有108頁\編輯于星期一Severalreportshaveshownthatthetwo-stageprocedure

canreducetherateofcomplicationssuchas

infection,skinsloughing,andpost-traumaticarthritis13–15.現(xiàn)在是88頁\一共有108頁\編輯于星期一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.現(xiàn)在是89頁\一共有108頁\編輯于星期一Skinsloughingandinfectionarethemostimportant

earlypostoperativecomplications17.Pre-existing（已存在）severe

softtissueinjuryprecludes（不能）openreductioninviewof（考慮到）the

potentialwoundproblemsduetoischemia（缺血）orinfectionof

thesofttissues.現(xiàn)在是90頁\一共有108頁\編輯于星期一Theprecarious（不確定的）bloodsupplyinthisregion

ofthetibiacancontributeto（有助于）theproblemsofbothnonunion

andinfection18.現(xiàn)在是91頁\一共有108頁\編輯于星期一Intensive（加強的）outweigh（勝過，強過）

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]現(xiàn)在是92頁\一共有108頁\編輯于星期一hingeaxis（鉸鏈軸）[h?nd?]plastercast（石膏）optimal（最佳的）manuscript（手稿，文章）現(xiàn)在是93頁\一共有108頁\編輯于星期一Inthepresentstudy,therewerefour

casesofskinsloughing,twoofsuperficialinfections,and

onlyoneofdeepboneinfection.現(xiàn)在是94頁\一共有108頁\編輯于星期一Surgicalapproachesare

nowplannedbasedonthe

requirementsofthefracture

pattern,keepinginmindthesoft-tissueconstraintsofthe

individualinjury.現(xiàn)在是95頁\一共有108頁\編輯于星期一Theincisionsarekeptatleast7cmapart

topreventsoft-tissueischemiaandsecondarywoundbreakdown.現(xiàn)在是96頁\一共有108頁\編輯于星期一Intensive（加強的）debridement,minimizationofsofttissuestrippingandproperuseofantibioticsareusefulfor

preventinginfection.現(xiàn)在是97頁\一共有108頁\編輯于星期一Delayedunion,especiallyinthemetaphysealportion,is

alsoaproblemwithpilonfractures.Wenoteda7.1%

delayedunionrateinthisseries.現(xiàn)在是98頁\一共有108頁\編輯于星期一Theseverityoftheinjury

andpoorbloodsupplytothedistaltibiamayoutweigh（勝過，強過）the

affectsofanyparticularapproachwhenitcomestononunionordelayedunion,anditisalsoprobablycausedby

tibialbonedefectafterfixationofthefibula.Butthereis

notdecidedforthefibulafixation19,20.現(xiàn)在是99頁\一共有108頁\編輯于星期一Wethink