胫骨远端解剖钢板治疗Pilon骨折

Treatment of Pilon Fracture with Anatomical Plate of Distal Tibia

目的:探讨胫骨远端解剖钢板治疗Pilon骨折手术时机和疗效。方法:对1995～2000年接受手术治疗的45例Pilon骨折患者进行随访。骨折类型:Ⅰ型14例,Ⅱ型16例,Ⅲ型15例。22例行切开复位胫骨远端解剖钢板内固定,23例行有限切开内固定辅以外固定。术后平均随访40.8月。结果:按Mazur评分系统,45例中优37例,良5例,可2例,差1例。术后并发症:伤口不愈合(4例),伤口感染(2例),骨折延迟愈合(1例),踝关节肿胀(8例),踝关节僵硬(1例)。结论:治疗方法的选择应遵循个体化原则。术前伤口处理、术中关节面解剖复位和应用解剖钢板坚强内固定是提高Pilon骨折临床疗效的有效措施。

Objective:To evaluate the timing and effect of surgical treatment of tibia Pilon fracture with anatomical plate of distal tibia. Methods:Forty-five patients with tibia Pilon fracture operatively treated between 1995 and 2000 were followed up. According to the Ruedi-Allgower classification, there were 14 cases of type I fracture, 16 cases type II fracture and 15 cases type III fracture. During operation,22 patients had fractures open reduced and internal fixation with anatomical plate,23 patients had limited open reduction and internal fixation coupled with external fixation. The average period of follow-up of these 45 patients were 40. 8 months. Results: According to Mazur' s criterion, the results of the treatment were evaluated as excellent in 37 patients,good in 5 patients,fair in 2 patients and poor in 1 patient. Complications included wound dehiscence in 4 cases, infection in 2 cases, delayed union of fracture 1 case, swell of ankle joint in 8 cases and stiffness of ankle joint 1 case. Conclusion: The principle of individualization is important to select the correct method to treat Pilon fracture. Preoperative well handling of wound, anatomical reduction of joint surface and stable fixation with anatomical plate are effective methods to improve the clinical results of tibia Pilon fracture.