分步延期手术治疗Rüedi-Allgower Ⅲ型Pilon骨折疗效分析

Clinical effect of step-by-step extension internal fixation in treatment of Pilon fracture staged Rüedi-Allgower Ⅲ

目的探讨应用分步延期内固定治疗Rüedi-Allgower Ⅲ型Pilon骨折的临床疗效。方法 2007年1月至2010年12月收治Rüedi-Allgower Ⅲ型Pilon骨折28例,其中闭合性骨折22例,开放性骨折6例;入院后均行急诊手术,开放性骨折组先行清创术,一期行腓骨骨折切开复位钢板固定,胫骨骨折应用超关节外固定架临时固定或跟骨牵引;待肿胀消退、软组织条件改善后,二期拆除外固定行胫骨远端骨折内固定治疗。二期手术间隔时间9～21 d,平均12d。16例采用切开复位、植骨、解剖型钢板内固定,12例采用有限切开复位,植骨,锁定钢板内固定术。结果术后随访6～50个月,平均38个月。术后并发症:皮缘部分坏死2例,浅表感染2例,术后无外固定针眼相关软组织感染,无深部感染、骨髓炎病例,骨折延迟愈合2例,创伤性关节炎2例,骨折畸形愈合1例。按Mazur评分系统评分,优10例,良13例,可3例,差2例,优良率82.1%。结论分步延期内固定治疗Ⅲ型Pilon骨折,既能促进严重损伤的软组织条件明显改善,减少软组织相关并发症,又能解剖恢复关节面和可靠内固定,有助踝关节的早期功能锻炼和康复,是治疗复杂Rüedi-Allgower Ⅲ型Pilon骨折一种安全有效的方法。

To study the clinical effect of step - by - step extension internal fixation in treatment of Pilon fracture staged Rtledi - Allgower III. Methods Twenty eight cases of Pilon fracture staged Rtiedi - Allgower III were primarily treated with emergent surgery. Then these cases of open fracture were firstly given with debridement and received first stage fibular open reduction with steel plate fixation and seeond stage distal tibial fracture with internal fixation. Sixteen cases treated with open reduction, bone grafting, and anatomic plate fixation,and 12 eases received semi - open reduct：[on, bone grafting and locking proximal humerus with plate internal fixation. Results All eases were followed - up for 6 to 50 months with an average of 38 months. Their complications were as follows： 2 eases with partial necrosis of flap margin, 2 eases with superficial infection, 2 cases with delayed union, 2 cases with traumatic arthritis, and 1 case with deformed healing. According to Mazur scoring, results were excellent in 10 cases, good in 13 cases, favorable in 3 cases and poor in 2 cases. The rate of excellent operation was 82.1%. Conclusion Step - by - step extension internal fixation is a safe and effective surgery for treatment of Pilon fracture staged III. It can improve the condition of soft tissue with serious damage, decrease complications, renewing articular surface, and it may be helpful for the recovery of ankle function.