选择性手术治疗复杂Pilon骨折的临床分析

Clinical analysis of selective operation and individualized treatment of complicated Pilon fracture

目的探讨复杂Pilon骨折选择性手术个体化治疗的手术时机、骨折固定方式、并发症及治疗效果。方法回顾性分析武警黑龙江总队医院2015年1月至2018年1月收治复杂Pilon骨折36例患者的资料,针对患者的伤情选用锁定板手术内固定治疗、外固定架结合克氏针、螺丝钉固定治疗,对其手术方法、治疗时机、治疗效果及术后并发症等方面进行临床分析。结果随访12~36个月,平均随访时间为18.6个月。本组36例骨折患者,术后一期骨性愈合31例,骨折延迟愈合5例;开放性损伤创面二期愈合7例、遗有创伤性踝关节炎7例。按Mazur评分标准:优11例,良18例,可5例,差2例,优良率80.6%。结论复杂Pilon骨折在个体化治疗时,选择适宜的手术治疗时机、恰当的手术入路及有效的骨折固定方式,术后配合功能锻炼,能有效恢复肢体功能,减少术后并发症的发生。

Objective To investigate the best timing, method of fracture fixation, occurrence of complications and therapeutic effect of individualized treatment of complicated Pilon fracture. Methods Review has been conducted among 36 cases of complicated Pilon fracture treated in People’s Armed Police Corps Hospital in Heilongjiang Province from January 2015 to January 2018. Operation of open reduction and internal fixation, limited internal fixation combined with external fixation, or screw fixation were selected for different patients’ conditions. Clinical analysis has been performed on the method of operation, timing of treatment, effect of treatment and postoperative complications. Results All 36 cases were followed up for 12 to 36 months in this team, with an average of 18.6 months. Among them, 31 cases were fracture healing by first intention, 5 cases were fracture delayed union;7 cases were open fracture healing by second intention, 7 cases were traumatic arthritis. According to Mazur’s standards of grading: 11 excellent cases, 18 good cases,5 fair cases, 2 poor cases, the excellent and good rate was 80.6%. Conclusion Based on the type of fracture, the injury degree of skin and soft tissue, the best way to individualized treatment of complicated Pilon fracture is to select suitable timing of surgical treatment, proper surgical approaching, proper fracture fixation and correct function exercises in postoperation. It could effectively restore limb function, reduce occurrence of complications.