动力外固定器加有限内固定治疗Pilon骨折

Dynamic external fixator combined with limited internal fixation for Pilon fractures

目的探讨动力外固定器结合有限内固定治疗Pilon骨折的临床疗效。方法自2000年以来,采用该方法治疗Pilon骨折27例,按Ovadia和Beals分型,Ⅲ型9例,Ⅳ型12例,Ⅴ型6例。手术采用T型动力外固定器跨踝关节固定,对胫骨远端关节面采用经皮克氏针撬拨复位、克氏针或有限切开复位螺丝钉固定。术后1～3周松开外固定器的动力锁纽,活动踝关节。结果术后27例均获得随访,功能评定按美国矫形外科足踝协会评分标准进行评分,优良率达82.3%。结论有限内固定避免了软组织的并发症和骨不连,动力外固定架使踝关节早期活动,避免了踝关节的僵直,因而是Pilon骨折较为理想的方法之一。

Objective To explore the effects of dynamic external fixator combined with limited internal fixation in treatment of Pilon fractures. Methods 27 cases of Pilon fracture have been treated with this method since 2000. According to the classification of Ovadia &Beals, 9 were type Ⅲ, 12 were type Ⅳand 6 were type Ⅴ. The “T”shaped unilateral modular external fixator was applied through the ankle joint. The reduction of the distal tibia articular surface was manipulated by percutaneous Kirschner pins and fixed by Kirschner pins or / and cannulated screws. The dynamic locking button was loosened at 1 to 3 weeks postoperatively to exercise the ankle joint. Results All the patients were followed up for 11 to 34 months. According to the ankle hind foot scale of American Orthopedics Foot &Ankle Society (AOFAS), 22 cases achieved excellent and good results (82.3%). Conclusions Limited internal fixation can avoid wound complications and nonunion. Dynamic external fixator can permit early exercises of ankle so as to avoid stiffness of the joint. Therefore, combination of both is a satisfactory treatment for Pilon fractures.