外固定支架在高能量Pilon骨折分期治疗中的价值探讨

Significance of external fixator in the staged management of high energy Pilon fracture

目的探讨使用外固定支架分期治疗高能量Pilon骨折的意义。方法从2004年2月至2007年3月共收治10例高能量Pilon骨折患者,男性8例,女性2例,年龄22～72岁,平均56.2岁。初期治疗选用单臂外固定支架(Orthofix)以及Hoffmann-Ⅱ外固定支架(Stryker)。待患者全身情况好转、创面愈合或软组织条件改善后,再转换为切开复位内固定或微创闭合内固定(MIPPO)。结果10例患者平均外固定支架使用时间为13.2d(7～49d),均转换为坚强内固定治疗。软组织开放伤口和手术伤口均获得愈合,所有病例均获得骨性愈合,无骨筋膜室综合症、骨髓炎发生。1例开放性Pilon骨折外固定后发现感染,在感染控制后7周更换内固定,同时放置庆大霉素珠链,术后骨折愈合。结论对于高能量Pilon骨折,正确评估局部软组织条件和全身情况,合理使用外固定支架进行损伤控制,适当时机更换内固定的分期治疗办法是安全有效的。

Objective To evaluate the significance of external fixator in the staged management of Pilon fractures. Methods Ten patients with high-energy Pilon fractures were managed from February 2004 to March 2007. In 10 patients, there were 8 males and 2 females, which average age was 56.2 years （ranged 22 to 72 years）. All patients were operated with external fixations of single-arm external fixator（Orthofix） or Hoffmann external fixator-Ⅱ （Stryker） in the early stage. Then it was replaced by strong internal fixations through open reduction or close reduction with the technique of minimally invasive percutaneous plate oesteosynthesis （MIPPO）, after the general conditions were controlled, the wound surface was healed and the soft tissues were improved. Results The mean time of external fixation was 13.2 days （ranged 7 to 49 days）. Then external fixations were replaced by internal fixations. All the traumatic and operative wounds healed up. All bone fractures united. No compartment syndrome or osteomyelitis occurred in this study. One case happened open Pilon fracture infected after external fixation was treated with gentamycin-released beads for 7 weeks, and then using internal plate fixation. The infection was controlled and the bone reunited. Conclusions For high-energy Pilon fractures, staged management, with correct evaluation of local soft tissue injuries and general conditions, proper damage control via external fixator, and right time to change to internal fixator is safe and effective.