61例Pilon骨折的临床治疗及分析

Surgical treatment of tibial pilon fractures and clinical analysis of 61 cases

目的 探讨胫骨闭合性Pilon骨折的治疗方法及影响临床效果的因素。方法 分析我科治疗的6 1例Pilon骨折患者 ,根据治疗前后的X片资料和随访结果 ,对不同类型 (Ruedi Allgower分型 )的骨折 ,比较保守治疗、有限内固定、有限内固定结合外固定架、坚强内固定 4种治疗方法的临床疗效。结果 参照Helfet提出的标准判断 ,保守治疗临床疗效差 ,手术治疗优良率为 80 %。胫距关节面达到解剖复位的骨折疗效优良率为 90 %。对Ⅱ型和Ⅲ型骨折 ,坚强内固定组应用胫腓骨钢板 ,其内支撑作用能够更有效地恢复肢体长度和达到关节内骨折解剖复位 ,临床疗效优良率高于其他手术组。结论 临床治疗效果与骨折类型、治疗方法有关。应根据骨折的具体情况具体分析 ,采用不同治疗方法 ,手术治疗的效果优于保守治疗。对Ⅱ型和Ⅲ型骨折 ,当局部皮肤条件较好时 ,首选切开复位坚强内固定 ;当局部皮肤条件不好时 ,宜选择有限内固定结合外固定架治疗。

Objective To evaluate the clinical outcome of closed tibial pilon fractures treated with different methods.?Methods Sixty one patients were admitted and treated with conservative therapy, limited internal fixation, limited internal fixation combined with external fixation or solid internal fixation, their X ray data and follow up results were reviewed. The clinical results were compared among different types and evaluated according to the therapeutic methods respectively.?Results Take Helfet's criterion as reference, 25% of the patients had good or excellent results in conservative therapy group,they were all type Ⅰfractures. Ninty percent of the patients achieved anatomical reduction of tibial astragaloid joint had good or excellent result. Tibia and fibula plates were utilized in solid internal fixation group, their internal supports can restore limb length and achieve anatomical reduction of tibial astragaloid joint, the patients in this group had more satisfactory results than the other three groups.?Conclusion The clinical outcome are affected by the clinical type of the fractures , the quality of reduction achieved at surgery, and the specific surgical procedure by which the fracture was managed. Tibial Pilon fractures should be embodied and selection of therapeutic regimen should be individualized. Open reduction and internal fixation is superior to conservative therapy. For type Ⅱ and type Ⅲ fracture,when there is adequate blood circulation of local skin, solid internal fixation is the best selection;in contrast,when blood circulation of local skin is not adequate,limited internal fixation combined with external fixation should be selected. Restoring limb length and achieving anatomical reduction of tibial astragaloid joint is the therapeutic key.