超关节外固定支架联合切开有限内固定治疗严重Pilon骨折

Spanning External Fixator Combined with Limited Internal Fixation for Severe Pilon Fracture

目的探讨超关节外固定支架联合切开有限内固定治疗严重Pilon骨折的临床疗效。方法 2007年12月～2010年2月对25例高能量损伤的Pilon骨折,行胫骨切开复位有限内固定,内侧超关节外固定支架固定。结果手术时间80～210 min,平均95 min。2例术后出现浅表组织坏死,经换药后治愈。骨折愈合时间10～16周,平均13周。25例随访12～34个月,平均24个月。关节骨折复位采用Burwell&Charnley评分法:C1型全部解剖复位;C2型解剖复位8例,一般2例;C3型解剖复位4例,一般3例,差2例。术后12个月按Baird&Jackson的踝关节症状和功能评分法,优7例,良13例,可4例,差1例,优良率80.0%(20/25)。结论超关节外固定支架联合切开有限内固定治疗严重Pilon骨折能有效降低软组织并发症,提高关节面的复位质量。

Objective To evaluate the efficacy of spanning external fixator plus limited internal fixation for type C Pilon fractures. Methods From December 2007 to February 2010, 25 cases of severe Pilon fractures underwent tibial fixation and spanning external fixation. Results The operation time ranged from 80 to 210 rain with a mean of 95 rain. Two patients had necrosis of superficial tissues after the procedure, and then were cured by conservative therapy. The fractures were healed at an average of 13 weeks （range, 10 to 16） postoperatively. All the patients were available for a mean of 24-month follow-up （range, 12 to 34 months）. According to Burwell ＆ Charnley classification, all the cases of type C1 fracture, 8 cases of type C2, and 4 cases of type C3 achieved anatomical reduction; 2 patients with type C2 fracture and 3 patients with type C3 were fair; 2 cases of type C3 were poor. Twelve months after the operation, Baird ＆ Jackson scoring showed excellent in 7 patients, good in 13, fair in 4, and poor in 1. The rate of excellent and good was 80.0% （20/25）. Conclusions Spanning external fixator and limited internal fixation are effective for severe Pilon fractures. The procedure can decrease the rate of soft tissues complication and improve articular anatomical reconstruction.