三种方法治疗Pilon骨折的临床分析

Three therapeutic treatments and clinical analysis of tibial Pilon fractures

目的通过对胫骨闭合性Pilon骨折不同治疗方法的分析比较,旨在找出最佳治疗方案。方法回顾性分析自1996年4月～2003年6月胫骨闭合性Pilon骨折28例,根据治疗前后的X线片资料和随访结果,对不同类型(RuediAllgower分型)的骨折,比较有限内固定、有限内固定结合外固定架、坚强内固定3种治疗方法的临床疗效。结果随访8～26个月(平均152个月),发现3种治疗方法在临床疗效和并发症发生率上有明显差别,参照Helfet提出的标准判断,胫距关节面达到解剖复位的骨折疗效优良率为92%。对Ⅱ型和Ⅲ型骨折,坚强内固定组应用胫腓骨钢板,其内支撑作用能够更有效地恢复肢体长度和达到关节内骨折解剖复位,临床疗效优良率高于其他手术组。结论治疗的效果决定于原始损伤的程度、复位的质量和固定的稳定性。治疗方案的选择在胫骨闭合性Pilon骨折的治疗、预后中起重要的作用。

Objective:To evaluate the clinical outcome of closed tibial Pilon fractures treated with three methods,and put forward the best therapeutic method Method:Since Apr 1996 to Jun 2003,28 patients of closed tibial Pilon fractures were admitted and treated with limited internal fixation,limited internal fixation combined with external fixation or solid internal fixation,their X ray data and follow up results were reviewed The clinical results were compared among different types and evaluated according to the therapeutic methods respectively Result:All cases were followed up from 8 months to 26 months(average 15 2 months),after follow up,the outcome had great difference Take Helfet’s criterion as reference,Ninty two percent of the patients achieved anatomical reduction of tibial astragaloid joint had good or excellent result Tibia and fibula plates were utilized in solid internal fixation group,their internal supports can restore limb length and achieve anatomical reduction of tibial astragaloid joint,the patients in this group had more satisfactory results than the other two groups Conclusion:The results of operative treatment are dependent on the severity of initial injuries and the quality and stability of the reduction Proper selection of the surgical procedure plays an important role in the therapy and prognosis for patients of closed tibial Pilon fractures