复杂Pilon骨折的手术治疗

Surgery treatments of complicated Pilon fracture

目的 探讨Rüedi-AllgowerⅡ、Ⅲ型Pilon 骨折的手术时机,手术方法及并发症的防治.方法 2006年5月～2009年8月收治Ⅱ、Ⅲ型 Pilon骨折患者26例,年龄21～60岁,平均36.8岁.开放性骨折9例,闭合性骨折17例,合并腓骨骨折22例.胫骨骨折钢板固定16例.螺钉加克氏针固定2例,外固定架结合有限内固定7例,踝关节融合1例.结果 术后随访6～47月,平均30月.按Mazur 评分标准：优8例,良12例,可4例,差2例.优良率77%.结论 Rüedi-AllgowerⅡ、Ⅲ型Pilon骨折多为高能量损伤,影响其预后的因数很多.术前对损伤作出正确的评估,正确选择手术时机及合适的手术方法是治疗成功的关键.

Aim To discuss operative method,timing and prevention of complications of type Ⅱ,Ⅲ Pilon fractures.Methods 26 patients with Rüedi-Allgower type Ⅱ,Ⅲ Pilon fracture who had been treated in our ward from May 2006 to August 2009.Their average age was 36.8 years,ranging from 21 to 60 years.9 cases were open fracture and 17 cases were closed fracture.22 cases were accompanied with fibular fracture.16 cases of tibial fracture fixed with plate,2 cases were treated with limited iternal fixation with screw and kirschner wire,7 cases were treated whth the external fixators combined with limites internal fixation and 1 cases with arthrodesis.Results There was 6 to 47 months follow-up after the operation（average 30 months）.According to Mazur＇s criteria,the result was evaluated as excellent in 8 cases,good in 12 cass,fair in 4cases and poor in 2 cases.The excellent and good recovery rate was 77%.Conclusion Many factors can affact the prognosis of tibial pilon fracture.The key points for a successful operation are careful assessment or the injury,right procedure and the timing of surgery.