摘要
目的探讨有限内固定结合外固定支架治疗复杂Pilon骨折的临床价值。方法2002年4月～2004年12月,采取有限内固定结合外固定支架治疗复杂Pilon骨折11例,男6例,女5例,年龄20～71岁,平均42.8岁。按AO分型:B3型2例,C1型2例,C2型4例,C3型3例。本组病例全部为闭合型骨折,均合并腓骨远端骨折。均采用腓骨嵴后侧切口和标准的胫骨前内侧小切口,腓骨采用1/3管型钢板固定,胫骨远端采取有限内固定结合外固定支架固定。结果11例患者均获得随访,随访时间4～32个月,平均16.9个月。按照Mazur等制定踝关节的评分标准:优3例,良6例,可2例,无1例出现局部感染、创口裂开、外固定针松动、骨不连、关节僵硬及关节不稳等并发症,也无1例因创伤性关节炎而行关节融合术。结论有限内固定结合外固定支架治疗复杂Pilon骨折能减轻局部软组织的压力,避免局部皮肤坏死而引发的一系列并发症发生,具有切口小、软组织血运破坏少等优点,且固定持续、稳固,术后关节功能满意。
Objective To assess the clinical value of limited internal fixation combined with external fixators in treat ment for complex Pilon fracture.Methods From April 2002 to December 2004, 11 patients with complex pilon fracture were treated with limited internal fixation combined with external fixators. 6 males and 5 females were involved,aged from 22 to 46 years,the average age was 42.8 years （ranged from 20-70 years）.Occording to the AO classification,there were 2 cases type B3,2 cases type C1,4 cases type C2 and 3 cases C3.All these cases were closed fracture,distal fibula fracture.Fibula postero-medical approach and standard small tibial antero-medical approach were used.Fibula was fixed by 1/3 tubular plate. Distal tibia was fixed by limited internal fixation combined with external fixators. Results All 11 patients were available at the final follow-up,the mean period was 16.9 months （ranged 4- 32months）.According to Maiur＇s scoring system for ankle joint, the patients were classified as 3 excellent ,6 good, 2 fair and no any complications. Osteomyelitis,nonunion,ankylosing and instability of the joint, there is no operation of joint union because of wound asthritis.Conclusion Limited internal fixation combined with external fixations for Pilon fracture provides satisfactory function of the joint, it has many advantages,such as stable and durable fixation, small incision and little damage to soft tissue ,decreasing the pressure of soft tissue, avoiding the complications oecured by necrosis of the skin.
出处
《江西医药》
CAS
2005年第9期511-513,共3页
Jiangxi Medical Journal
