延期分步手术治疗高能量Pilon骨折

Delayed operation on treatment of hige-energy distal tibia Pilon fracture

目的:探讨高能量Pilon骨折的适宜手术方法、最佳手术时机及其手术疗效。方法:自2006年7月至2009年12月治疗高能量Pilon骨折29例,男23例,女6例;年龄21～54岁,平均36.8岁。采用Ruedi-Allgower分型:Ⅰ型3例,Ⅱ型16例,Ⅲ型10例。Ⅰ型骨折选择螺钉和克氏针固定,Ⅱ、Ⅲ型骨折选择薄的胫骨远端内侧三叶草钢板或外侧解剖型钢板固定。采用Mazur评分标准,从踝关节肿痛程度、步态、踝关节活动度等方面进行疗效评定。结果:无一例发生深部感染,也未出现内固定物折断、脱出等并发症。全部病例均获随访,时间6～42个月,平均28个月。骨折愈合时间10～32周,平均15周。根据Mazur评分,优15例,良10例,可3例,差1例。结论:伤后在局部软组织损伤恢复后,延期分步钢板内固定既能减轻软组织损伤程度,又能提供坚强内固定以利早期关节活动,是提高胫骨Pilon骨折手术疗效、减少局部并发症的有效措施。

Objective：To investigate the selection of operative methods,timing of operation and the effect of hige-energy distal tibia Pilon fracture.Methods：From July 2006 to December 2009,29 patients with hige-energy distal tibia Pilon fractures were treated,including 23 males and 6 females with an average age of 36.8 years old ranging from 21 to 54 years.According to Ruedi-Allgower classification on Pilon fractures,there were 3 cases of typeⅠ,16 of type Ⅱ and 10 of type Ⅲ.The typeⅠpatients were fixed by screws and Kirschner wires and the cases of typeⅡand Ⅲ were fixed by filmy clover steel plates closed up tibia medial border or tibia lateral anatomical steel plates.All patients were evaluated by the tumid algesic level of ankle joint,gait,the activity of ankle joint according to Mazur score.Results：None of patients occurred complications such as deep infection,fractured internal fixation and prolapsed internal fixation.All patients were followed up from 6 to 42 months （averaged 28 months）.The time of fracture healing was from 10 to 32 weeks（means 15 weeks）.According to the ankle score of Mazur,the results were excellent in 15 cases,good in 10 cases,fair in 3 cases,poor in 1 case.Conclusion：The step-by-step delayed open reduction and internal fixation for hige-energy distal tibia Pilon fracture is an effective method with fewer complications and good function after the recovery of soft tissue injury.The method can not only mitigate the level of soft tissue injury,but also is beneficial to the early joint motion with rigid fixation.