前外侧入路治疗RuediⅡ-Ⅲ型Pilon骨折

The operative treatment of Ruedi Ⅱ-Ⅲ Pilon fractures with the ventr-lateral approach

目的:探讨前外侧入路治疗严重Pilon骨折的疗效。方法:2002年2月至2008年3月,采用前外侧入路治疗的RuediⅡ-Ⅲ型Pilon骨折63例,男36例,女27例;年龄19～71岁,平均37岁。受伤至治疗时间为2h～19d,平均8d。按Ruedi分型:Ⅱ型32例(合并局部软组织挫裂伤6例,其中4例为开放骨折),Ⅲ型31例(合并局部软组织挫裂伤9例,其中8例为开放骨折)。术后观察创面愈合情况、骨感染、骨不连、骨折畸形、踝关节活动度及疼痛程度,评价手术疗效。结果:4例患者创面不愈合,经过植皮或皮瓣覆盖创面愈合,5例因骨不连超关节固定时间长,导致踝僵硬活动受限。所有患者获得随访,时间8～31个月,平均15.3个月。骨愈合时间8～14周,平均10周。按Helfet疗效评价标准:优28例,良30例,差5例。结论:采用前外侧入路治疗RuediⅡ-Ⅲ型Pilon骨折能取得满意的治疗效果,可有效避免并发症的发生。

Objective：To investigate the effects of the ventr-lateral approach in treating severe Pilon fracture.Methods：From February 2002 to March 2008,63 patients with RuediⅡ-ⅢPilon fractures were treated with the the ventr-lateral approach,including 36 males and 27 females with an average age of 37 years ranging from 19 to 71 years.The mean time from injury to operation was 8 days（ranged for 2 h-19 d）.According to the Ruedi classification system,typeⅡwas 32 cases（6 cases of them combined with soft tissue lesion,4 with open fracture） and typeⅢwas 31 cases（9 cases of them combined with soft tissue lesion,8 with open fracture）.The clinical effects were evaluated according to Helfet criteria and the complications were observed including condition of wound healing,infection,bone union,deformity union,motion of the ankle,the degree of the pain and so on.Results：The first intention achieved in 59 cases,the delayed healing in 4 cases.Stiffness of the ankle was found in 5 cases because of bone disunion.All patients were followed up from 8 to 31 months with an average of 15.3 months.The ranging in bone healing time was from 8 to14 weeks with an average of 10 weeks.According to the Helfet criteria,28 cases obtained excellent results,30 good,5 poor.Conclusion：The operative treatment of RuediⅡ-ⅢPilon fractures with the ventr-lateral approach can obtain satisfactory results and avoid complications effectively.