Ⅱ、Ⅲ型高能量Pilon骨折的手术治疗

Surgical treatment of high-energy type Ⅱ/Ⅲ Pilon fracture

目的探讨Ⅱ、Ⅲ型高能量Pilon骨折的手术治疗时机以及不同手术方式的临床效果。方法对我院46例Ⅱ、Ⅲ型高能量Pilon骨折患者的临床资料进行回顾性分析,手术治疗分外固定支架结合有限内固定组和延期切开复位锁定加压钢板（LCP）固定＋髂骨植骨组,临床结果按照踝关节Mazur评分标准进行综合评价。结果术后46例患者均获得随访,随访时间为8个月~36个月,平均25.8个月。经Mazur踝关节评分标准系统评价,优27例,良10例,可6例,差3例,优良率为80.4%。其中外固定组优良率70.6%,延期锁定加压钢板（LCP）固定＋髂骨植骨组优良率82.8%,2组优良率无明显统计性差异（P〉0.05）。结论两种手术方式对治疗Ⅱ、Ⅲ型高能量Pilon骨折均有良好的效果;延期切开复位锁定钢板固定＋植骨在减少术后的软组织并发症及骨折重建质量的临床观察上优于外固定组。

Objective To evaluate the surgery timing and management protocol for high-energy Pilon fracture,and to determine whether long-term results of one of different management protocols for severe tibial Pilon fractures offer advantages over the other.Methods In a retrospective study,46 patients with high-energy type Ⅱ/ Ⅲ Pilon fracture were treated with limited open reduction and external fixation group and open reduction internal fixation with locking compression plate（LCP） ＋bone grafting group.We evaluated the clinical outcomes according to the rating scale of the modified Mazure score system.Results All patients were followed up at an average of 25.8 months（range 8 to 36 months）after surgery.According to Mazur function assessment system,the curative effect was excellent in 27 patients,good in 10,fair in 36 and poor in 3.The excellent and good rate was 80.4%.The rate in the external fixation group was 70.6%,and 82.8% in the LCP open reduction and internal fixation group.There was no statistically significant difference between the three groups（P0.05）.Conclusion Both the two operational methods for the treatment of high-energy type II / III Pilon fracture have good effect.In terms of postoperative soft tissue complications and clinical observation of fracture reconstruction quality,open reduction internal fixation with locking compression plate（LCP） ＋bone grafting group is superior to the limited open reduction and external fixation group.