严重Pilon骨折的手术治疗

Surgical Treatment of Severe Tibia Pilon Fractures

目的探讨严重Pilon骨折的不同手术方法、手术时机及治疗效果。方法对1999年5月至2006年6月间46例严重Pilon骨折分别采用有限内固定、有限内固定结合外支架固定及三叶草钢板内固定等方法进行手术治疗。按AO分类方式，所有患者均为C型，C1型10例，C2型22例，C3型14例。开放性骨折11例。闭合性骨折35例。结果所有患者术后均获得8～48个月的随访，平均20个月。踝关节功能按Mazur评价，优21例，良12例，可8例，差5例。主要并发症包括2例皮肤坏死，2例皮肤软组织感染，1例骨感染。5例钉道感染。结论 严重Pilon骨折根据不同的骨折类型、软组织损伤程度及医疗条件选择不同的手术方式和手术时机，均可取得良好的治疗效果。

Objective To discuss the operative methods ,timing choices and outcomes of surgical treatment of severe tibia Pilon fractures. Methods Since May 1999 to Jun 2006,46 patiens with severe tibia Pilon fractures were admitted and treated with limited internal fixation,limited internal fixation combined with external fixation or internal fixation with cloverleaf plate. All the cases were of type C fracture according to AO classification,there were 10 cases of type C1 ; 22 cases of type C2 ; 14 cases of type C3.11 cases were open fracture and 35 close ones. Result All cases werefollowed-up form 8 to 48 momths,average 20 months. According Mazur scale for ankle joint,the result of the treatment was evaluated as excellent in 21 patients ;good in 12 patients ;fair in 8 patients and poor in 5 patients. Complications included wound dehiscence in 2 cases ;infection in 2 cases ;osteomyelitis in 1 case and screw path infections in 5 cases. Conclusion In order to get satisfactory results,it is important to have the right choice and timing of surgery and correct method of fixation in severe tibia Pilon fracture.