高能量Plion骨折的手术治疗

High energy Plion fractures treated by operation

目的探讨高能量Plion骨折的治疗方法,并评估其疗效。方法2000年1月～2005年6月共收治高能量Plion骨折56例,随机分为有限切开内固定结合外固定(治疗组27例)与切开复位内固定(对照组29例)两种方法治疗。结果47例患者(治疗组22例,对照组25例)得到随访,随访时间为12～48个月,平均18.7个月。治疗组临床疗效满意,无切口感染、螺钉松动及软组织并发症;对照组有3例感染,1例骨不连发生,发生率为13.79%。踝关节骨折复位情况(Marsh复位评分法)评定:治疗组优10例,良6例,中等4例,差2例,优良率72.73%;对照组优16例,良5例,中等4例,差1例,优良率84.00%,两组比较差异无显著性(P>0.05)。踝关节功能评分(Mazur评分法):治疗组12例优秀,7例良好,2例一般,1例差,优良率86.32%;对照组优10例,良5例,中等6例,差4例,优良率64.00%,两组比较差异有显著性(P<0.05)。结论影响高能量Plion骨折的疗效因素很多,如骨折的整复固定和踝关节解剖关系的恢复,更重要的是如何避免局部软组织并发症。有限切开内固定结合外固定有利于早期活动,避免关节僵硬,有效预防骨不连,是治疗高能量Plion骨折的较好的方法。

[Objective] To investigate the treatment method for high energy Plion fractures and evaluate the resuits. [Methods] From January 2000 to June 2005, 56 cases were randomly divided into two groups： Groups 1 （27 cases） was treated by limited open reduction and internal fixation combined with external fixation; Groups 2 （29 cases） was treated by open reduction and internal fixation. [Results] 47cases （Groups 1：22; Groups 2：29） were followed up with a mean period of 18.7 months （12-48 months）. Neither infections of wound nor soft tissue complication was found; however, 3 cases had infection and 1 cases had bone healing complications in Groups 2. According to Marsh classification of reduction of the articular surface of the ankle, the quality of, reduction of articular surface showed in Groups 1：10 excellent and 6 good, 4 fair and 2 bad, the rate of excellent and good was 72.73%; in Groups 2：16 excellent and 5 good, 2 fair and 1 bad, the rate of excellent and good was 84.00%, there was not significant difference between the two groups （P 〉0.05）. According to Mazur ankle joint scoring system, clinical results demonstrated in Groups 1：12 excellent and 7 good, 2 fair and 1 bad, the rate of excellent and good was 86.32%; in Groups 2：10 excellent and 5 good, 6 fair and 4 bad, the rate of excellent and good was 64.00%, there was significant difference between the two groups （P 〈0.05）. [ Conclusion ] Beside the reduction of fracture and restoring anatomical articular surface, to avoid soft tissue complication is also important. Limited internal fixation combined with external fixation enable early ankle joint motion, and can help to prevent anlde joint stiffness after fixation, and also helps to effectively decrease bone healing complications. It is a satisfying technique to treat high energy Plion fractures.