高能量Pilon骨折治疗策略

Strategies for treatment of high-energy tibial pilon fracture

胫骨Pilon骨折属于关节内骨折且软组织损伤重,因此其处理对骨科医生仍是挑战。本讲座旨在通过复习文献提出一种高能量Pilon骨折的治疗策略。文中简要复习了Pilon骨折的基本知识和分类,对几个有争议的问题进行讨论,并根据研究进展和笔者临床经验提出高能量Pilon骨折的治疗方案,建议采用分期治疗骨折:Ⅰ期采用超关节外支架临时固定,待软组织条件改善后,Ⅱ期行确定性治疗。然而,目前尚无胫骨高能量Pilon骨折的最佳治疗方案。

Management and treatment of pilon fracture provide a significant challenge to orthopedic surgeons, as they are typically intra-articular and associated with extensive soft tissue damage. The purpose of this lecture was to present a treatment strategy. First,we briefly reviewed basic knowledge in pilon fracture, as well as classification of pilon fractures. Then,we discussed some controversies in the management of high-energy pilon fracture. Finally,we proposed a treatment algorithm according to the literatures and authors＇ collective clinical experience. The use of a staged treatment protocol was recommended： initial spanning external fixation, definitive fixation followed by good recovery of soft tissues. However,the optimum management for tibial pilon fractures is yet undetermined.