Pilon骨折手术治疗方法选择

Selections of surgical treatment of pilon fractures

目的探讨几种Pilon骨折手术方法的适应证及效果。方法1994年1月至2006年1月期间共手术治疗Pilon骨折54例(男36例,女18例);年龄17～69岁(平均36岁);开放性骨折15例、闭合性骨折39例;Ruedi-AllgowerⅠ型9例、Ⅱ型15例、Ⅲ型30例;AI分型B_3/C_1型8例,C_2型17例,C_3型29例。采用闭合复位或有限切开复位加外固定架治疗37例,切开复位、钢板螺钉内固定17例。结果16例失去随访,38例获1年以内随访,17例获1年以上随访,平均随访时间36个月(6～60个月);骨折全部愈合,平均愈合时间21周,5例出现内翻畸形愈合。3例伤口皮缘浅表坏死(经局部换药后痊愈),5例出现骨性关节炎表现(其中1例行踝关节置换术)。Mazur评分结果,优12例,良13例,可7例,差6例。结论Pilon骨折的治疗应根据骨折类型、软组织损伤程度选择手术方法,才能提高疗效,减少并发症。

Objective To investigate the indications and the effect of operative treatment of Pilon fractures. Methods Fifty-four cases of Pilon fractures were treated with surgical methods from January 1994 to January 2006. There were 36 males and 18 females, the average age was 36 years （ranged 17-69 years old）, 15 cases were opened fractures and 39 cases were closed. According to Ruedi-Allgower classification, there were 9 cases of type Ⅰ fracture, 15 cases of type Ⅱ and 30 cases of type Ⅲ （8 cases of type B3/C1, 17cases of type C2 and 29 cases of type C3 in AO classification）. 37cases were treated with closed reduction or limited open reduction and external fixation, 17cases with open reduction and internal fixation. Results Sixteen cases could not be followed up, the remaining thlrty-eight cases were followed up for an average of 36 months （ranged 6-60 months） in which 17 cases were followed over one year. All fractures united, but malunion was observed in 5 patients, the time to fracture union averaged 21week （ranged 11-36weeks）. The complications included that superficial wound edge necrosis was only noted in three cases which healed by local wound care without a further soft tissure coverage procedure and 5 cases suffered from severe traumatic arthritis in which 1 case was treated with replacement of ankle joint. After evaluated according to the criteria of Mazur＇s score, there were 12 casea assessed as being excellent, 13 cases as good, 7 cases as fair and 6 cases as poor. Conclusions The treatment protocol of Pilon fractures should be determined based on the type of fracture and severity of soft-tissue injury to improve the effect and reduce the complications.