Pilon骨折不同治疗方法回顾性分析

Retrospective analysis of the treatment of the Pilon Fracture

目的通过对66例不同类型Pilon骨折的不同治疗方法及其疗效进行回顾性分析，为治疗方法的选择提供参考依据。方法对66例Pilon骨折，按照Ruedi--Allgowe的分型法：Ⅰ型12例，Ⅱ型29例，Ⅲ型25例。根据骨折类型，软组织损伤程度及各种并发症的情况，采取各自不同的治疗方法：手法复位“U”型石膏外固定27例，切开复位内固定39例。结果经6个月～47个月（平均14个月）的随访，按着Helft的疗效评价标准，手法复位组优良率为96％，手术组优良率为92％。结论Ⅰ、Ⅱ型骨折预后优于Ⅲ型骨折；若病例选择合适且手法正确，手法复位石膏外固定组可取得接近于手术组的疗效；对Pilon骨折，手法复位后必须评价复位效果，其远期疗效仍需观察。

Objective To provide evidential reference for the treatment methods through a retrospective analysis on 66 cases of Pilon fracture. Methods By following Ruedi-Allgower classification method, the 66 eases of Pilon fracture were classified into type Ⅰ, 12 cases, type Ⅱ, 29cases, type Ⅲ, 25 eases. Based on frature types, degree of soft tissue injury, and other complications, different treatments were offered-27 were adopted with manipulative reduction with ＂U＂ plaster cast external fiction, while 39 were adopted with open reduction with internal fixation. Results According to the Helft efficiency evaluation standard, the efficiency rate for the manipulative reduction group was 96%, and 92% for the open reduction group, after the 6-47 months follow-up visits （14 months in average）. Conclusion Prognosis for type Ⅰ and Ⅱ is considered being more expected than the type Ⅲ. With correct manipulation on the right cases, the clinical effect of manipulative reduction with plaster cast external fixation may receive almost the same result as for open reduction with internal fixation. For Pilon fracture, effect of restoration is primary to be considered, and its long-term effect needs to he observed.