Pilon骨折的治疗

Treatment of Pilon fractures

目的探讨Pilon骨折治疗方法的适应证。方法治疗35例(38肢)Pilon骨折,Ⅰ型8例,Ⅱ型20例,Ⅲ型7例。采用闭合复位石膏外固定(5例)、跟骨牵引辅以小夹板外固定(3例)、三叶草支撑钢板内固定(15例)、单纯单臂外固定支架固定(4例)、有限手术切开螺钉内固定单臂外固定支架固定(7例)、截肢术(1例),有7例采用自体髂骨植骨,3例采用同种异体骨植骨,2例采用人工骨植骨。结果随访4月～6年,优良23例,可9例,差3例,有1例术后皮瓣坏死,行二期转移皮瓣修复,有3例术后关节负重行走疼痛,行踝关节融合治疗。结论根据Pilon骨折的不同分型,采用合适的治疗方法。手术的关键在于恢复腓骨的长度和保持胫骨关节面的完整性。

Objective To investigate the indications for Pilon fractures. Methods 35 cases (38 limbs) with Pilon fracture were treated. According to Rüedi Allgwer classification, 8 cases were classified as typeⅠ, 20 cases typeⅡ, and 6 cases type Ⅲ. They were treated with manipulative reduction and external fixation by cast (5 cases), calcaneal traction with splints fixation (3 cases), open reduction and internal fixation by cloverleaf buttress plate (15 cases), closed or open reduction with unilateral external fixati...