植骨、解剖形钢板固定治疗胫骨Pilon骨折16例

Treatment of Pilon fracture with one stage bone grafting and anatomical plate

目的探讨手术治疗胫骨Pilon骨折的临床疗效、手术时机。方法2006年3月至2009年1月,我院采用一期植骨、解剖形钢板固定治疗胫骨Pilon骨折16例。骨折类型:Ⅱ型13例,Ⅲ型3例。胫骨骨折:胫侧钢板固定5例,腓侧钢板固定11例;15例合并腓骨骨折均行重建钢板固定。结果16例均获得随访,平均随访18个月(6个月-3年),骨折平均愈合时间4.5个月。术后并发症情况:钢板外露2例,创伤性关节炎4例。按Mazur踝关节症状与功能评分系统评分:优5例,良7例,可2例,差2例,优良率为75%,并发症发生率为37.5%。结论一期植骨、解剖形钢板固定治疗胫骨Pilon骨折的疗效满意,选择好手术时机及固定方式,能提高临床疗效,减少并发症。

Objective To evaluate the effects and timing of operation for treament of Pilon fracture with one stage bone grafting and anatomical plate. Methods Form Mar 2006 to Jan 2009, 16 patients with Pilon fracture were treated with one stage bone grafting and anatomical plate. According to the Ruedi -Allgower classification, 13 were type Ⅱ, 3 were type Ⅲ. When treating tibia fractures, 5 cases were fixed with medial anatomical plate and 11 cases with lateral. The 15 cases of fibula fractures were reducted and fixed with plate. Results All the patients had been followed up for an average of 18 months, and the average healing time was 4.5 months. The complications were found in postoperitive, including of exposure of plate in 2 patients and traumatic arthritis in 4 patients. According to Mazur criterion, an excellent outcome was found in 5 eases, good in 7, fair in 2, poor in 2, the excellent and good rate was 75%, and the complications was 37.5%. Conclusion The satisfactory clinical outcome can be obtained by one stage bone grafting and anatomical plate. An appropriate selection of timing of operation and interal fixation can improve the clinical outcome and reduce the complications.