胫骨Pilon骨折治疗方法的临床研究

The therapeutic strategy of the tibial pilon fracture

目的探讨总结胫骨pilon骨折治疗方法和疗效,以提高胫骨pilon骨折的治疗效果。方法 2005年1月～2008年5月,共治疗pilon骨折32例,按Ruedi-Allgower分型,I型3例,II型17型,III型12例,其中18例合并腓骨骨折。开放性骨折7例,均行急诊手术;闭合性骨折25例,受伤至行手术时间为7～14天,平均8.6天。27例行钢板内固定,5例行有限螺钉内固定结合外固定支架固定,合并腓骨骨折均使用直型复位钢板内固定。采用Mazur踝关节功能评分进行疗效比较和随访,平均随访时间1.8年。结果根据Mazur踝关节功能评分:优20例,良8例,可2例,差2例;优良率为87.5%。无深部感染病例发生。结论正确评估局部皮肤和软组织损伤及骨折类型。

Objective To study the treatment and curative effect of tibial pilon bone fracture,improve the Treatment Effectiveness.Methods From January 2005 to May 2008,we totally cured 32 cases of the pilon bone fracture.11 cases of them wereduetofalls,10casescaused by traffic accident,8 by blows,and 2 by the sport sprains.Typed according to Ruedi-Allgower,3 cases of type I,17 cases of type II,and 12 cases of type III.There are 18 cases compare with fibula fracture,on all of which 25 cases were closed fracture,first handling the soft tissue injuries,fix the fracture protemporely,which were threated with open reduction and internal fixation after the soft tissuecured.There are 7 cases of open fracture,on all of which were performed an emergency operation;On 7 cases were performed incision and restoration with internal fixation of steel plate,5 cases were performed limited bolt fixation with external fixation support.w hich compared with fibula fracture fixed with internal fixation of rectate steel plate.There were 21 cases bone graft at the first time.Results According to the ankle joint functions standard of Mazur,20 cases have excellent result,8 cases good,2 cases fair,2 cases bad.The rate of excellent result was 87.5 percent.After operations,there were no deep infection.Conclusion It was the base to grasp the operative occasion,select correct therapeutic methods and acquire satisfactory therapeutic effect that evaluate the local skin,soft tissue injuries and the types of fracture correctly.