有限切开内固定联合超踝外固定架治疗在Ruedi-AllgowerⅢ型Pilon骨折治疗中的应用

The Application of External Fixator Combined with Limited Internal Fixation in Treating Pilon Fractures of Ruedi-Allgower Type Ⅲ

目的：探讨有限切开内固定联合超踝外固定架在治疗Ruedi-Allgower Ⅲ型Pilon骨折中的临床疗效。方法2014年3月~2015年3月30例Ⅲ型Pilon骨折患者均接受了有限切开内固定联合超踝外固定架治疗。支架远端螺钉固定于距骨颈或跟骨，近端螺钉固定于胫骨骨折近端，使踝关节可以距下关节为中心活动。术后4~6周调节万向关节开始踝关节功能锻炼。结果术后24例切口Ⅰ期愈合；6例切口经相应治疗后Ⅱ期愈合；切口Ⅰ期愈合率为80%。30例患者均获随访，随访时间8~12个月，平均11个月。骨折均愈合，愈合时间16~24周，平均21周。踝关节症状和功能评分为：优8例、良14例、可6例、差2例，优良率为73.3%。结论有限切开内固定联合超踝外固定架治疗Ⅲ型Pilon骨折可减少切口不愈合的发生，有利于踝关节早期活动，较好恢复踝关节功能，是治疗Ⅲ型Pilon骨折的有效方法。

Objective To explore the clinical effects of external fixator combined with limited internal fixation in treating pilon fractures of Ruedi-Allgower type Ⅲ. Methods From March 2014 to March 2015,30 patients with pilon fractures of Ruedi-Allgower type Ⅲ were treated with an external fixator combined with limited internal fixation in our de-partment. The fixator was placed across the ankle joint,and the fixation of fracture was enhanced by a combined use of limit-ed internal fixtion. The distal 2 pins were inserted into the talus and the tuberosity of calcaneus so that the subtalar joint was treated as axis during ankle movement. At approximately postoperative 4 or 6 weeks,the articular hinge was released and the patient began with ankle exercise. Results Healing of incision by first intention was obtained in 24 cases,and healing by second intention was obtained in 6 cases after related treatment. The rate of healing by first intention was 80%. 30 patients were followed up 8~12 months （mean,11months）. All the fractures healed within 16 to 24 weeks（mean,21 weeks）. Ac-cording to Tornetta ankkel joint scoring system,clinical results were excellent in 8,good in 14,fair in 6 and poor in 2,and the excellent and fine rate was 75. 5%. Conclusions The treatment of using external fixator combined with limited inter-nal fixation is an effective method to treat pilon fractures of Ruedi-Allgower typeⅢ,which can effectively decrease compli-cations of wound healing,and preferably restore the function of ankle joint by allowing ankle joint motion early.