胫骨Pilon骨折的疗效观察

Observation on the curative effect of Pilon fracture of tibia

目的：探讨胫骨Pilon骨折分期治疗效果。方法：收治胫骨Pilon骨折患者36例，采用Ruedi-Allgower分型：Ⅰ型6例，Ⅱ型18例，Ⅲ型12例。Ⅰ、Ⅱ、Ⅲ型骨折选择胫骨远端内侧解剖锁定钢板或外侧“L”型锁定钢板固定，合并腓骨骨折用管型或腓骨远端解剖钢板。采用Mazur评分标准行疗效评定。结果：1例发生骨髓炎，其余无并发症。骨折愈合时间12～28周，平均16周。根据Mazur评分，优18例，良11例，可6例，差1例。结论：骨折发生后予以跟骨牵引、抬高患肢、加强消肿等处理措施，局部软组织改善后，采用二期骨折切开内固定术既能减少局部并发症，又能提供骨折端稳定以进行早期功能锻炼，是提高胫骨Pilon骨折手术疗效的有效措施。

Objective:To explore the staging treatment effect of Pilon fracture of tibia.Methods:36 patients with Pilon fracture oftibia were selected,and they were divided into three types according to Ruedi-Allgower:6 cases of type Ⅰ,18 cases of type Ⅱ,12cases of type Ⅲ.Distal tibia inside anatomical locking plate or lateral "L" type locking plate fixation were selected for type Ⅰ,Ⅱ,Ⅲ fractures,tube type or anatomic plate of distal fibula were selected for combination of fibula fracture.Efficacy was assessedusing Mazur score criteria.Results:1 case had osteomyelitis,there was no other complications.The healing time of fracture was 12to 28 weeks,and the average was 16 weeks.According to Mazur score,18 cases were excellent,11 cases were good,6 cases weresatisfactory,1 case was poor.Conclusion:After the fracture,calcaneus traction,limb elevation,strengthening the swelling and othertreatment measures were used,after local soft tissue improvement,the application of fracture open internal fixation at two stage notonly can reduce the local complications,but also provide the stability of fracture end in order to carry out early functional exercise,it was an effective measure to improve the surgical effect of Pilon fracture of tibia.