高能量胫骨Pilon骨折术式选择及疗效相关因素

Operative treatments of high energy Pilon fractures and its relative effecting factors

目的 通过3种术式疗效分析，探索不同情况高能量胫骨Pilon骨折的手术方法，并浅析影响胫骨Pilon骨折疗效的相关因素。方法 对38例单侧胫骨Pilon骨折分别行急诊切开复位内固定术（A组）、延期切开复位内固定术（B组）、Orthofix公司单侧带关节外固定架结合有限内固定（C组）手术。结果 术后随访12～48个月，平均30个月。手术疗效用经Mazur评分系统评定：优10例，良14例，町6例，差8例，优良率63．2％。结论 如果选择好手术适应证及时机，此3种手术方法治疗胫骨Pilon骨折均有较好疗效。影响手术疗效的因素除骨折类型、胫骨关节面的复位质量、腓骨骨折的复位和固定、移植骨填充及适宜固定物的选择等外，还与手术适应证的选择及手术时机的把握、骨折周围软组织损伤情况有关。

Objective To study 3 kinds of effective operative treatments of high energy Pilon fractures,and analyze relative effecting factors. Methods Thirty-eight cases of high tibia fracture were treated respectively by emergency operative reduction,delayed open reduction and articulated external fixator（Orthofix,Italy）. Results The average followed-up was 30 months（range, 12 to 48 months） after the operations. According to Mazur＇s criterion,the excellent was found in 10 cases,good 14 cases,fair 6 cases,poor 8 cases,the excellent rate was 63.2%. Conclusion The 3 kinds of operative treatments are effective if operator can select exactly indication and time of operation. Discouraged results of Pilon fractures are significantly related to fracture type, reduction status and time of operation, selection of operation indication,reduction and fixation of fibular fracture,and bone grafting etc. Besides, the results are significantly affected by the indication,time of operation and especially the severity of soft tissue injury.