Журнал «Травма» Том 25, №3, 2024
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Хірургічна тактика при переломах дистального відділу великогомілкової кістки. Огляд літератури
Авторы: Бур’янов О.А., Цапенко Г.С., Омельченко Т.М.
Національний медичний університет імені О.О. Богомольця, м. Київ, Україна
Рубрики: Травматология и ортопедия
Разделы: Справочник специалиста
Версия для печати
Резюме
Актуальність. Переломи дистального епіметафіза великогомілкової кістки (перелом pilon) становлять 5–7 % від усіх переломів великогомілкової кістки та 10–15 % від усіх переломів кісток нижньої кінцівки. Частка незадовільних результатів лікування при переломах pilon залишається високою і досягає 38–40 %. Важливим фактором, що обумовлює такий високий відсоток незадовільних результатів лікування, є відсутність лікувальних алгоритмів, прийнятих протоколів лікування та системи прогнозування наслідків лікування. Мета: провести аналіз особливостей сучасної хірургічної тактики в разі переломів дистального відділу великогомілкової кістки, визначити дискусійні і невирішені питання, окреслити можливі причини значної кількості незадовільних результатів лікування цієї категорії пацієнтів, а також шляхи поліпшення результатів лікування. Матеріали та методи. Проведено огляд 878 публікацій в базі PubMed за останні 15 років. Відібрано та проаналізовано 210 публікацій. Застосовано методи аналітичної та описової статистики. Результати. Серед дискусійних питань, що найчастіше обговорюються в літературі та відносно яких відсутній консенсус або загальноприйнятий підхід, що має доказовість та обґрунтовану тактику, потрібно виділити наступні: вибір часу хірургічного втручання; вибір методу та засобу фіксації; раціональна тактика конверсії металоостеосинтезу; необхідність та значення відновлення малогомілкової кістки під час лікування переломів pilon; значення кісткової пластики та пріоритетність відновлення анатомії великогомілкової за принципом колон; місце первинного артродезу в хірургічній тактиці лікування переломів pilon. Висновки. Вказані питання потребують подальшого дослідження з розробкою нових обґрунтованих алгоритмізованих протоколів лікування, що базуватимуться на достатній доказовій базі та системі прогнозування результатів.
Background. Fractures of the distal tibial epimetaphysis (pilon fracture) account for 5–7 % of all tibial fractures and 10–15 % of all lower extremity bone fractures. The percentage of treatment failure in pilon fractures remains high and reaches 38–40 %. An important factor causing this is the lack of algorithms, accepted treatment protocols, and a system for predicting the effects of therapy. Purpose of the study: to analyze the features of modern surgical tactics in case of distal tibia fractures, to identify controversial and unresolved issues, to outline the possible reasons for a significant number of poor treatment outcomes, as well as to outline ways to improve them. Materials and methods. A review of 878 publications in the PubMed database over the past 15 years was conducted. 210 publications were selected and analyzed. The methods of analytical and descriptive statistics are applied. Results. Among the most debatable issues in the literature regarding which there is no consensus or a generally accepted approach that has evidence and justified tactics, the following should be highlighted: the choice of the time of surgical intervention; selection of method and means of fixation; rational tactics for osteosynthesis conversion; necessity and significance of fibula restoration during the treatment of pilon fractures; the importance of osteoplasty and the priority of restoring tibial anatomy according to the “column” principle; the place of primary arthrodesis in the surgical treatment for pilon fractures. Conclusions. These issues require further research with the development of new substantiated algorithmized treatment protocols based on a sufficient evidence base and a system for predicting the outcomes.
Ключевые слова
дистальний епіметафіз; великогомілкова кістка; перелом pilon; огляд літератури
distal epimetaphysis; tibia; pilon fracture; literature review
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