高能量Pilon骨折手术时机及方法选择探讨

Choice of surgical opportunity and management of high-energy Pilon fractures.

目的探讨高能量Pilon骨折手术时机及治疗方法的选择。方法25例高能量Pilon骨折患者采用解剖型钢板进行急诊或延期手术治疗，骨折类型：Rviedi—AllgSwer骨折分型Ⅱ型4例、Ⅲ型21例；开放性骨折8例，闭合性骨折17例。8例开放性骨折和6例闭合骨折采用急诊清创复位、解剖型钢板内固定术，肿胀严重的11例闭合型骨折延期内固定术，合并腓骨骨折进行相应处理，术后平均随访32个月，根据Mazur等制定的踝关节症状与功能评分系统对手术关节进行功能评估。结果手术关节功能评估：优10例、良11例、可3例、差1例，优良率84％；术后并发症：感染2例，皮肤坏死1例，创伤性关节炎2例。结论高能量Pilon骨折根据不同的骨折类型、软组织损伤程度选择正确的手术方式和手术时机，可取得良好的治疗效果。

Objective To explore surgical opportunity and management of high-energy Pilon fractures. Methods Twenty-five cases of the high-energy Pilon fractures were treated with anatomic type plate one-staged or two-staged delayed. According to the Rvedi-Allgower classification,there were 4 cases of type Ⅱ fractures and 21 cases of type Ⅲ fractures. 8 cases were open fractures and 17 cases were close fractures. 8 cases open fractures and 6 cases close fractures were treated with anatomic type plate one-staged. 11 cases close fractures with serious soft tissue swell were treated two-staged delayed. The combined fibular fractures were fixed accordingly. All cases were followed up for 32 months after operation in average （ range 17 to 76 months）. Results According to Mazur＇s criteria, the surgical result was evaluated as excellent in 10 patients ,good in 11 ,fair in 3 and poor in 1. Postoperative complication in- cluded infection in 2 cases,necrosis of skin in 1 case and traumatic arthritis of the ankle joint in 2 cases. Conclusion In order to get a satisfactory result, it is important to choose the right timing of surgery and correct procedure in high-energy Pilon fracture.