累及矢状面与冠状面Pilon骨折的治疗效果分析

Analysis of the therapeutic effect of Pilon fractures involving sagittal and coronal plane

目的探讨应用前侧或内侧钢板治疗累及矢状面与冠状面Pilon骨折的临床疗效。方法收集2005~2015年收治的成人胫骨Plilon骨折患者68例,根据Rüedi-Allg9wen分型,选择25例Ⅲ型患者进行治疗。其中男性20例,女性5例;年龄19~54岁,平均38.4岁。左侧5例,右侧20例;受伤至手术时间为7~15d,平均(10.2±3.4)d。对有肿胀情况的患者进行脱水或抬高患肢等手段进行消肿,并做好防护措施,待肿胀完全消退及皮肤出现皱折后立即手术,所有患者均接受手术和康复治疗。结果对25例患者进行6~16个月的随访,平均随访(10.3±2.8)个月。骨折愈合时间为2~5个月,平均(3±1.5)个月。采用Mazur评分系统评估手术疗效,25例患者优20例、良2例、可3例。术后并发症包括延迟愈合1例、关节退行性变8例和皮肤浅表坏死3例,无感染病例、无创面不愈合、无内固定失效病例。结论正确选择手术时机,根据软组织情况、骨折累及平面灵活选择固定方式是取得良好手术效果的关键。

Objective To investigate the clinical efficacy of the application of the anterior or medial plate in the treatment of Pilon fracture involving sagittal plane and coronal plane. Methods From 2005 to 2015,68 adult patients with tibial Pilon fractures were collected in our hospital,and 25 patients which belonged to type Ⅲ were chosen to receive treatment according to the Rtiedi-Allgowen typing. There were 20 males and 5 females, aged from 19 to 54 years with an average of 38.4 years. There were 5 cases on the left side and 20 cases on the right side. From getting injured to having surgery,the patient experienced 7-15 d with an average of （ 10. 2 ± 3.4） d. In patients with swelling symptoms, good protective measures like dehydration, elevation limb and other means were taken to reduce swelling. After the swelling completely subsided and skin wrinkled, the patients immediately received surgery. Finally all patients underwent surgery and rehabilitation. Results Twenty patients were followed up for 6-16 months with an average of （ 10. 3 ±2. 8） months. Fracture healing time was 2 to 5 months with an average of （3 ± 1.5） months. Mazur scoring system was used to evaluate the surgical outcome. There were 20 excellent cases, 2 good cases, and 3 fair cases. Postoperative complications included 1 case of delayed healing,8 cases of joint degeneration and 3 cases of superficial necrosis of the skin, but there was no infection case, no wound nonunion or internal fixation failure cases. Conclusion The key point of achieving good surgical results is to choose the correct timing of surgery and flexible fixed mode aceording to the soft tissue and the fracture-involved plane.