手术治疗Pilon骨折的难点及对策

Difficulties and Countermeasures of the surgical treatment of Pilon fractures

目的探讨Pilon骨折的手术治疗难点及对策。方法手术治疗88例Pilon骨折患者,包括闭合性骨折41例,开放性骨折47例。开放性骨折根据不同的骨折类型和软组织损伤情况选择不同治疗方法。采用Mazur踝关节评分系统价治疗效果,根据不同Gustilo分型的手术治疗比较开放性骨折和闭合性骨折的治疗效果。结果本组所有患者均得到随访,平均随访时间14～29(22.4±6.57)月,采用Mazur踝关节症状与功能评分系统评价:优31例,良35例,可17例,差5例。开放性骨折优良率61.7%,闭合性骨折优良率90.2%。两种骨折治疗结果差异明显(P<0.05)。开放性骨折GustiloⅡ型优良率71.8%;ⅢA型优良率45.4%;ⅢB型优良率25.0%,统计学比较差异有意义(P<0.05)。结论软组织处理和骨折复位程度是治疗Pilon骨折的关键。

Objective To discuss difficulties and countermeasures of the surgical treatment of Pilon fractures. Methods Eighty-eight pilon fractures were treated Ruedi-Allgower classification： 4 cases of type I , 31 cases of type Ⅱ , 53 cases of type ft. 47 cases of open fractures. 41 cases of close fractures. The 41 fracture with soft tissue damage were classified according Gustilo classification： 32cases of type Ⅱ , llcases of type mA,4 cases of type roB. Choose a different treatment according to the different types of fractures and soft tissue injuries. Results All patients were followed with an average of 22.4±6.57 months （ 14-29 months）. According to The Mazur ankle symptoms and functional scoring system： 31 cases excellent, 35 cases good, 17 cases fair, 5 cases poor. Excellent rate of open fractures was 61.7%, Excellent rate of close fractures was 90.2%. Excellent rate in Patients with soft tissue damage of Gustilo type Ⅱ wasT1.8%; Excellent rate of type mA was 45.4; Excellent rate of type ⅢB was 45.4. Conclusion Soft tissue and fractures extent is the key to the treatment of Pilon fractures.