有限内固定结合外固定治疗高能量Ⅱ、Ⅲ型Pilon骨折

Surgical treatment of serious Pilon fracture with Limited internal fixation combined external fixation

目的探讨有限切开复位内固定结合胫骨超关节外固定支架治疗Ⅱ、Ⅲ型Pilon骨折的疗效。方法2003年3月至2006年12月间采用小切口开放复位、拉力螺钉或小支撑钢板结合外固定支架治疗Ⅱ、Ⅲ型Pilon骨折13例。结果全部病例得到随访,随访时间平均12个月,骨折全部愈合,无延迟或畸形愈合。按Mazur评分标准,优4例,良6例,中2例,差1例,优良率83%。结论切口复位有限内固定结合外固定支架固定的手术方法,具有创伤小、复位满意、固定可靠且并发症少等优势,是治疗高能量损伤后软组织条件不良的Pilon骨折的首选方案之一。

Objective To obtain the effects of the over-articular external fixation combined with limited internal fixation in the treatment of serious Pilon fracture. Methods 13 cases of Pilon fractures were carried out open reduction operation and limited internal fixation by lag screws or small surppotive plates with over-articular external fixator from Mar. 2003 to Dec. 2006. Results The follow-up period varied from 6 to 24 moths with a mean of 12 months. Bone union was shown in all cases. According to Mazur scoring system, excellent 4 cases, good 6 cases, fair 2 cases, poor 1 case. The total percentage of good to excellent clinical results was 83%. Conclusion Operative treatment of Pilon fracture by over-articular external fixation combined with limited internal fixation has get satisfactory results with anatomic reduction and firm fixation. It offers an practical alternative for the high-energy caused Pilon fracture with adverse soft tissue condition.