Pilon骨折的微创治疗

Minimally invasive percutaneous osteosynthesis for tibial Pilon fracture

目的探讨微创技术治疗Pilon骨折的手术方法、手术指征及其手术疗效。方法采用微创手术治疗的26例Pilon骨折患者,平均年龄46.2岁;骨折类型:Rüedi-AllgwerPilon骨折分型Ⅰ型12例、Ⅱ型10例、Ⅲ型4例。3例行空心螺钉固定,14例行MIPPO技术钢板固定,9例应用外固定支架,其中4例使用外固定支架结合有限内固定。术后平均随访18.2个月。结果采用Mazur方法评估手术疗效,26例患者,优18例、良7例、可1例,优良率92.3%。术后并发症包括创面不愈合1例、复位不良1例、关节退行性变2例。结论正确选择手术时机,术中良好复位,根据骨折类型选择微创固定方式是治疗Pilon骨折有效方法。

Objective To report the technique, indication and results of minimally invasive percutaneous osteosynthesis in treatment of the tibia Pilon fracture. Methods A retrospective analysis of 26 consecutive cases of tibial Pilon fracture was conducted. Their average follow up was 18.2 months long. Their average age was 46.2 years old. According to Ruedi Allgower Pilon fracture classification, 12 were of type Ⅰ, 10 type Ⅱand 4 type Ⅲ. 3 patients underwent close reduction and internal fixation with lag screw coupled with plaster splint; 14 patients had close reduction and internal fixation with minimally invasive percutaneous plate osteosynthesis (MIPPO); close reduction and external fixation were applied in 9 patients, 4 of whom were also treated with limited internal fixation. Results According to Mazurs criteria, the surgical result was evaluated as excellent in 18 patients, good in 7 and fair in 1. No poor result was found. Postoperative complications included wound dehiscence in 1 cases, poor reduction in 1 cases and late degenerative changes of the ankle joint in 2 cases. Conclusion Good timing of surgery, correct reduction and minimally invasive percutaneous osteosynthesis can result in satisfactory outcomes for the tibial Pilon fracture.