胫骨Pilon骨折分型治疗疗效分析

Treatment of Tibial Pilon's Fracture according to the Fracture Classification

目的:探讨胫骨Pilon骨折治疗方法的选择。方法:2004年1月—2007年12月收治30例Pilon骨折,3例急诊手术,11例Ⅱ型及10例Ⅲ型延期平均12d手术;3例Ⅰ型行石膏外固定,13例Ⅱ型行切开复位克氏针或螺钉或支持钢板固定,9例Ⅲ型行切开复位支持钢板固定,2例Ⅲ型行外固定架固定结合切开复位有限内固定,3例行跟骨牵引保守治疗。结果:29例(96.7%)得到随访。骨折愈合时间平均13周,无骨不连,1例皮肤坏死,3例浅表皮肤感染。临床疗效评价:16例优,10例良,3例差,优良率89.6%。结论:根据骨折分型及软组织条件选择适宜手术时机及合理治疗方式,可取得满意疗效。

Objective：To explore of the treatment methods of tibial Pilon＇s fracture. Methods：Thirty patients with tibial Pilon＇ s fracture were treated from January 2004 to December 2007. Three patients were treated by emergency operation. Eleven pa tients with type-Ⅱ fracture and ten patients with type-Ⅲ fracture were treated by selective operation. The average interval form injury to operation was 12 days. Three patients with type-I fracture were treated by external plaster fixation. Thirteen patients with type-Ⅱ fracture were treated by ORIF and fixed with Kirschner wire or screw or supporting plate. Nine patients with type-Ⅲ fracture were also treated by ORIF and fixed with supporting plate, and two patients were fixed by external fixator frame combining with limited internal fixation and three patients were treated by calcaneus traction. Results： Totally, twenty nine （96.7%） patients were followed up. The average time of fracture union was 13 weeks. There was no patient with nonunion, one patient with cutaneous necrosis and three patients with scarfskin infection. The evaluation of clinical therapeutic effect showed that 16 cases were excellent and 10 cases were good and 3 cases were fair. The good rate was 89.6%. Conclusion：The suitable operation time and treating method according to the type of fracture and the condition of soft tissue will make the thera- peutic effect satisfactory.