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微创手术结合中医辨证施治治疗复杂Pilon骨折 被引量:7

Mininally invasive surgery combined with Chinese dialectical theory of governance for treatment of complex Pilon's fracture
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摘要 [目的]探讨有限内固定加外固定支架治疗复杂Pilon骨折的临床疗效。[方法]自2000年以来,作者采用该方法治疗Pilon骨折78例,男51例,女27例,年龄20~79岁(平均36岁),按Ovadia、Beals分型,Ⅲ型27例,Ⅳ型35例,Ⅴ型16例,新鲜骨折53例,陈旧性骨折25例。闭合性损伤57例,开放性损伤21例。均行手术治疗,采用克氏针、螺丝钉内固定结合外固定支架超踝关节固定,术后1.5~2个月拆除外固定支架、小夹板固定活动踝关节。[结果]术后78例均获得随访,随访1~3年,平均20个月,所有骨折均骨性愈合,2例有约5°左右外翻,3例开放损伤患者因皮肤、软组织挫压明显缺血坏死需Ⅱ期行皮瓣移植修复治疗,4例出现创伤性关节炎症状,需服用非甾体类抗炎药,其中1例行踝关节融合术。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87.2%。[结论]有限内固定结合外固定支架能有效、坚强固定骨折端,避免软组织感染和骨不连,是治疗Pilon骨折理想的方法之一。 [ Objective] To investigate the clinical effect of treatment of complex Pilon g fractures with limited internal fixations and external fixators. [ Method] Since 2000, 78 cases of complex Pilon's fractures with limited internal fixations and external fixators were treated, of which male 51cases ,female 27cases ,aged 20 -79 years old,average 36 yrs . According to Ovadia and Beals classification, type Ⅲ 27 cases,type Ⅳ 35 cases,type Ⅴ 16 cases,fresh fracture 53cases,old fracture 25 cases,close frac- ture 57 cases, open fracture 21 cases. They were all treated by Kirsschner wires and screws together with external fixators . External fixator were removed at 1.5 -2 months after operation and splints were used and began ankle movement. [ Result] All cases were followed up after operation. The following observation time was 1 - 3 years , average 20 months . All fractures were ostcal concrescence. Two cases were evaginate about 5 degree. Three cases were open injury and needed flap grafting rehabilitation because skin and soft tissue were compressed severely and necrotized. Traumatic artharitis occurred in 4 cases, nitric oxide-releasing anti-inflammatory drug was needed. One case was treated with arthrodesis. The functional evaluation was completed according to standard of American Orthopedic Association of Foot and Ankle. The excellent rate was 87.2%. [Conclusion] Limited internal fixation and external fixator is one of the effective way of treatment of Pilon's fracture because it can immobilize the sections of fracture and avoid infection of soft tissue and nonunion of fracture.
出处 《中国矫形外科杂志》 CAS CSCD 北大核心 2008年第4期265-268,共4页 Orthopedic Journal of China
关键词 Pilon骨折 中西结合 有限内固定 外固定器 Pilon fracture combination of Chinese and western medicine limited internal fixation external fixator
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