Pilon骨折的治疗体会

Treatment of Pilon fractures

目的探讨Pilon骨折的治疗方法、手术时机及疗效。方法 32例Pilon骨折患者,对Ruedi-Allgower分型4例Ⅰ型者,采用跟骨牵引加超踝关节小夹板外固定2例,采用松质骨螺钉或可吸收钉加石膏外固定2例;对28例Ⅱ、Ⅲ型者,行解剖型钢板内固定21例,行有限内固定并辅以石膏外固定5例,2例Ⅱ型开放性骨折者用外固定架固定。植骨13例。结果 32例均获随访,时间12-18个月。骨折均愈合。疗效根据Teeny和Wiss提出的评分系统：优23例,良5例,可3例,差1例,优良率为87.5%。结论选择合适的固定方式及最佳的手术时机是治疗Pilon骨折成功的关键。

Objective To investigate the treatment of Pilon fractures,timing of surgery and its effects.Methods 32 cases of Pilon fractures were recruited.In patients with Ruedi-Allgower type Ⅰ 4 cases,2 patients were treated with calcaneal traction and ultra-small splinting of ankle joint,and 2 were treated with cancellous bone screws or absorbable screw plaster external fixation.In 28 cases of type Ⅱ,Ⅲ fractures,21 patients were treated with routine anatomic plate fixation and limited internal fixation,5 patients were supplemented with plaster fixation and 2 cases of type Ⅱ open fractures were treated with external fixator.Bone graft were performed in 13 cases.Results 32 patients were followed up for 12 to 18 months.All got bone union.According to Teeny and Wiss scoring system,the results were excellent in 23 cases,good in 5,fair in 3 and poor in 1,and the excellent and good rate was 87.5%.Conclusions Selection of the appropriate fixation mode and the best timing of surgery are keys of the treatment of Pilon fracture.