开放性Pilon骨折的手术治疗

The suegical treatment of open Pilon fractures

目的探讨开放性Pilon骨折的治疗方法。方法 2006年5月～2010年1月收治开放性Pilon骨折患者36例,平均年龄35.8岁(22～60岁)。按照Rüedi-Allgower分型[1]其中Ⅱ型16例,Ⅲ型20例;合并腓骨骨折32例。胫骨骨折Ⅰ期钢板固定20例,Ⅱ期钢板固定4例;外固定架结合有限内固定12例。腓骨骨折均使用钢板内固定。结果术后经4～26个月(平均12个月)随访。均获得骨性愈合,平均愈合时间3.5个月。按Mazur评分标准:优16例,良13例,中4例,差3例,优良率约80%。结论 术前对软组织损伤的准确评估,正确选择内固定方法,关节面的复位是治疗开放性Pilon骨折的重要环节。

Objective To explore the treatment of open Pilon fractures. Methods 36 patients with open Pilon fracture had been treated in our department between May 2006 and January 2010. Their average age was 35.8 years （ranging from 22 to 60 years）. According to Ruedi -- Allgower type. 16 cases were type If , 20 cases were type III ;32 cases with fibula fractures. 20 cases of tibial fractures fixed with plate in stage I ,4 cases in stage II . 12 cases were treated with the external fixators combined with limited internal fixation. All of fibula fractures were fixed by plate. Results With the 4-26 months （average 12 months） follow--up after the operation. All cases were healing, average healing time 3.5 months . According to Mazur＇s criteria, the result was evaluated as excellent in 16 cases, good in 13 cases, fair in 4 cases and poor in 3 cases. The excellent and good recovery rate was 80%. Conclusions The accurate preoperative evaluation of soft tissue injury and the correct choice of internal fixation method and reduction of the joint surface have important links for treatment of open Pilon fractures.