胫骨远端解剖锁定钢板治疗复杂Pilon骨折

Distal Tibial Anatomic Locking Plate in the Treatment of 28 Cases with Complex Pilon Fractures

目的探讨胫骨远端解剖锁定铜板内固定治疗复杂Pilon骨折的临床疗效和安全性。方法采用胫骨远端解剖锁定钢板内固定治疗Ruedi—AllgowerIII型Pilon骨折28例，男19例，女8例。年龄23—64岁，平均35．5岁。开放性骨折4例，闭合性骨折24例。随访观察骨折复住、骨折愈合、踝关节功能及并发症情况。结果本组28例患者中25例行腓骨固定。术后采用Burwell—Chamley影像学标准评定，24例患者获得解剖复位、4例达到功能复位。所有患者均获得随访，随访时间12—38个月，平均16个月。1例患者发生切口感染，经对症处理后愈合；1例患者发生切口皮肤坏死，采用皮瓣转移治疗后愈合。所有患者的骨折均在术后12W内获得骨性愈合。末次随访时采用Mazur踝关节评分系统评定患足功能，优10例、良14例、可4例。结论采用胫骨远端解剖锁定钢板内固定治疗复杂Pilon骨折符合Pilon骨折治疗的“3P”原则，解决了Pilon骨折治疗中固定与早期锻炼的矛盾，安全有效，值得推广应用。

Objective To investigate clinical curative effects and safety of distal tibial anatomic locking plate fixation for the treat- ment of complex Pilon fractures. Methods 28 cases of Ruedi - Allgowerl]I type Pilon fractures were treated with distal tibial anatomi- cal locking plate, 19 male patients and 8 female patients, aged 23 to 64, with average age of 35.5 years old. There are 4 cases of open fractures and 24 cases of closed fractures. The follow - up observation focused on fracture reduction, fracture healing, ankle joint func- tion and complications. Results Among the 28 patients, fibulas of 25 cases were fixed by operation. Evaluated by the Burwell - Charnley radiological assessment criteria, 24 patients realized anatomical reduction and 4 patients were with functional reduction. All patients were followed up for 12 to 38 months, with average period of 16 months. 1 patient with wound infection recovered after symp- tomatic treatment; 1 case with skin necrosis recovered after receiving skin flap transfer treatment. A11 patients had bone healing in 12 w after surgery. At the end of the follow - up, Mazur ankle score system used to assess the risk of foot function showed the result ： excel- lent in 10 cases, good in 14 cases and fair in 4 cases. Conclusion Distal tibial anatomic locking plate fixation of complex fractures conforming to ＂3P＂ principle of Pilon fracture treatment helps to solve the contradiction between the treatment of Piion fracture fixation and early exercise, thus it proves to be safe and effective and worthy to be widely applied.