外固定支架结合VSD治疗开放性Pilon骨折的疗效分析

External Fixation Combined with VSD for Open Tibia Pilon Fractures

目的探讨外固定支架结合VSD治疗开放性Pilon骨折的方法及评估其临床疗效。方法 2010年6月—2012年6月35例开放性Pilon骨折患者,Gustilo II和Ⅲ度开放性骨折,予以外固定支架及有限内固定结合负压封闭引流技术（VSD）治疗。术后观察伤口愈合情况,术后6周、3个月、及1年进行一次临床功能及影像学评估,临床功能评估采用Mazur评定疗效。术后右胫腓骨正侧位片评估骨折愈合及并发症等情况。结果所有患者都得到有效临床随访,随访时间12-24个月,平均13.8个月。术后患者切口均I期愈合,所有患者均达到固定愈合,愈合时间8-24周,平均13.8个月。3个月至半年取出外固定支架及有限内固定物。无伤口感染,皮肤坏死及固定物松动断裂等并发症。末次随访X线片示骨折已愈合。Mazur评分：优：27例,良5例,可2例,差1例,优良率91.4%。结论外固定支架结合VSD治疗开放性Pilon骨折具有伤口愈合好,临床效果好,骨性愈合满意,并发症少等优点。

Objective To explore the method and effect of external fixation combined with vacuum sealing drainage （ VSD） for open tibia pilon fractures.Methods Thirty-five patients of open tibia pilon fractures, which are the Gustilo type Ⅱ and Ⅲ , admitted from Jun. 2010 to Jun. 2012 were reviewed retrospectively. All of them were treated by external fixation combined with VSD. The would were observed post-surgery.All patients were followed-up at 6 weeks, 3 months, 6 months, 12 months and every 6 months after surgery by clinical exam and radiology. All patients were evaluated by Mazur evaluation. The bone healing and the complications were evaluated by anterior-posterior and lateral distal tibia X-ray. Results Thirty-five patients were followed up for average 13.8 months （ ranging from 12 to 24 months）. All of would have healed well. All of cases have the good bone healing and the meaning bone healing time is average ？？ months （ranging from 8 to 24 months）.The inter and external fixation were removed from 3 months to half year after surgery. All of them have no infection, skin necrosis and loosening or breakage of fixation. The bone have healed well at the last follow-up. According to Mazur evaluation standard,91. 4% were excellent or good.Conclusion The external fixation combined with VSD for open tibia pilon fractures have the advantage of would healing well, the excellent clinic result, the good bone healing and little complications.