胫骨Pilon骨折的手术治疗

Surgical treatment of tibia Pilon fracture

目的回顾性分析了治疗胫骨Pilon骨折的适宜手术方法、最佳手术时机及其手术疗效。方法对1993～1998年接受手术治疗的31例单侧胫骨岁,伤后至手术时间平均为7.2d。骨折类型Ⅰ型3例、Ⅱ型钢板内固定;15例行有限切开内固定并辅以外固定,其中应用外固定支架者5例、辅以石膏托者例;3例固定腓骨后未行胫骨内固定,使用外固定支架进行辅助固定。术后平均随访采用Mazur评分系统评估手术疗效,31例患者,优25例、3例、感染2例、延迟愈合1例和关节退行性变8例和条件灵活选择固定方式是取得良好手术效果的关键。

Objective To evaluate the choice of operative method, timing of surgery and the outcome of tibia Pilon fracture. Methods Thirty one patients with unilateral tibia Pilon fracture operatively treated between 1993 and 1998 were followed up. The average age was 39.4 years(range from 15 to 64 years). The average period between injury and surgery was 7.2 days. According to the Rüedi Allgwer classification, there were 3 cases of type Ⅰfracture, 14 cases type Ⅱfracture and 14 cases type Ⅲfracture. During operation, 13 patients had the fractures reduced and internal fixation was done with the cloverleaf plate, 15 patients had limited open reduction and internal fixation coupled with external fixation, which included 5 patients with the external fixation apparatus and 10 patients with plaster splint, in the remaining 3 cases, the fibular fractures were fixed with plate and tibia fractures were immobilizated with external fixation apparatus. The average period of follow up of these 31 patients was 30.2 months. Results According to Mazurs criterion, the result of the treatment was evaluated as excellent in 25 patients, good in 5 patients and fair in 1 patient. No poor result was found. Complications included wound dehiscence in 3 cases, infection in 2 cases, delayed union of fracture 1 cases and late degenerative changes of the ankle joint in 8 cases. Conclusion In order to get a satisfactory result it is important to have the right choice and timing of surgery and correct method of fixation in tibia Pilon fractures.