两种锁定钢板治疗RüediⅢ型Pilon骨折的疗效比较

目的比较万向锁定加压接骨板(variable angle locking compression plate,VA-LCP)与普通锁定加压接骨板(locking compression plate,LCP)治疗RüediⅢ型Pilon骨折的临床疗效。方法回顾性分析2018年1月至2020年12月丹阳市人民医院骨科收治的48例RüediⅢ型Pilon骨折患者资料。其中17例采用VA-LCP内固定(研究组),男11例,女6例;年龄31~62岁,平均(46.3±6.7)岁。31例采用传统LCP内固定(对照组),男22例,女9例;年龄36~67岁,平均(48.7±7.6)岁。采集并比较两组患者的术前住院天数、手术时间、术后住院天数、切口愈合、骨折愈合、并发症、术后Burwell-Charnley骨折复位放射学评价和美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)踝与后足评分。结果患者均获随访,随访时间12~18个月,平均(15.2±4.4)个月。两组间年龄、性别、骨折侧别等一般资料以及手术时间、切口愈合、放射学评价、骨折愈合差异无统计学意义(P>0.05)。末次随访踝关节AOFAS评分,研究组70~95分,平均(85.4±11.3)分,其中优11例,良4例,可2例,优良率为88.2%;踝关节跖屈36°~51°,平均(40.3±7.5)°,背伸16°~25°,平均(20.7±3.6)°。对照组56~94分,平均(81.2±14.6)分,其中优18例,良8例,可5例,优良率为83.9%;踝关节跖屈32°~50°,平均(37.4±8.5)°,背伸13°~22°,平均(18.1±3.6)°。两组术后踝关节功能恢复满意,差异无统计学意义。研究组切口乙级愈合1例;对照组切口感染1例,乙级愈合5例,神经激惹1例,肌腱激惹4例。研究组软组织并发症情况优于对照组,差异有统计学意义(P<0.05)。结论VA-LCP与LCP两种钢板在固定RüediⅢ型Pilon骨折时,均能取得较好的临床疗效,具体选择视骨折情况而定。

Identification of risk factors for surgical site infection after type Ⅱ and type Ⅲ tibial pilon fracture surgery

BACKGROUND High-energy tibial pilon fractures are complex and severe fractures that are associated with a high risk of infection following open reduction and internal fixation.Infection can negatively impact patient outcomes.AIM To compare risk factors for postoperative infection after open reduction and internal fixation for a pilon fracture.METHODS Among the 137 patients included,67 developed a surgical site infection.Demographic,clinical,and surgical factors were compared between the two groups.A binary logistic regression analysis was used to determine the odds ratio(OR)and corresponding 95% CI for significant risk factors for postoperative infection.RESULTS The distribution of pathogenic bacteria among the 67 patients who developed a surgical site infection was as follows:Gram-positive,58.2%(n=39);Gramnegative,38.8%(n=26);and fungal,2.9%(n=2).The following factors were associated with postoperative infection(P<0.05):a Ruedi–Allgower pilon fracture type Ⅲ(OR=2.034;95%CI:1.109–3.738);a type Ⅲ surgical incision(OR=1.840;95%CI:1.177–2.877);wound contamination(OR=2.280;95%CI:1.378–3.772);and diabetes as a comorbidity(OR=3.196;95%CI:1.209–8.450).CONCLUSION Infection prevention for patients with a Ruedi–Allgower fracture type Ⅲ,surgical incision type Ⅲ,wound contamination,and diabetes lowers the postoperative infection risk after surgical management of tibial pilon fractures.

筋膜切开减压联合负压封闭引流在闭合性Ruedi-Allgower Ⅱ~Ⅲ型pilon骨折治疗中的临床效果

目的 探究筋膜切开减压联合负压封闭引流(VSD)在闭合性Ruedi-AllgowerⅡ~Ⅲ型pilon骨折患者治疗中的临床效果。方法 选择104例Ⅱ~Ⅲ型pilon骨折患者,按照随机数字表法分为观察组(52例)和对照组(52例)。对照组给予筋膜切开减压手术+常规治疗,观察组给予筋膜切开减压手术+VSD治疗,术后随访3个月。比较两组的围术期指标、踝与后足功能(AOFAS)评分、踝关节功能(Mazur)评分、踝关节恢复优良率和并发症发生率。结果 观察组住院时间、创面和骨折愈合时间短于对照组,差异均有统计学意义(t分别=11.45、15.15、2.06,P均<0.05);术后随访3个月,观察组患者的AOFAS评分和Mazur评分均高于对照组,差异均有统计学意义(t分别=11.73、16.46,P均<0.05),观察组的踝关节优良率高于对照组,术后并发症发生率低于对照组,差异均有统计学意义(χ^(2)分别=5.22、7.79,P均<0.05)。结论 筋膜切开减压联合VSD在闭合性Ruedi-AllgowerⅡ~Ⅲ型pilon骨折患者中的治疗效果明显,能有效缓解疼痛程度,改善关节受限,进而缩短康复进程,降低并发症发生概率。

Advantages of Ilizarov External Fixation in an Elderly Patient with Pilon Fracture with Severe Soft Tissue Injury and Severe Osteoporosis: A Case Report

Introduction: Pilon fracture in elderly individuals is characterized by senile skin atrophy, poor dermal extensibility, and thin subcutaneous tissue. The use of bulky internal fixation material can thus cause the swelling that accompanies the fracture to induce secondary injury to skin tissue. In addition, initiation of postoperative weight-bearing is delayed due to bone fragility and difficulties with partial weight-bearing, causing a tendency toward prolonged hospitalization. Mean duration of hospitalization after pilon fracture for elderly patients in our department was 79.2 days. Case Presentation: An 80-year-old woman with pilon fracture with soft tissue injury and severe osteoporosis was transferred to our department. The fracture was treated using Ilizarov external fixation. Fourteen days postoperatively, walking with full weight-bearing was permitted. The hospital stay was 28 days. The external fixator of the ankle was removed 87 days postoperatively, at which time the patient was anatomically and functionally recovered and able to walk unaided. Conclusion: Ilizarov external fixation may represent a useful option in elderly patients with pilon fracture showing severe soft tissue injury and severe osteoporosis. The present case provides evidence that this procdure can be successfully applied to the management of such pilon fractures in elderly patients.

Emergent and delayed hybrid external fixation management of tibial pilon fractures: A multicentric retrospective analysis of 80 patients

Objective:To report our experience with the hybrid external fixator in emergency.Methods:We assessed 80 cases of pilon fracture treated with the external fixator during the period of January 2009 and December 2016:55 men (69%) and 30 women (33%) with a mean age of 40 years (range between 16 and 70 ). About 45 occurred as isolated trauma, 35 instead were politrauma. Each patient underwent standard radiographic examination and a CT examination. There were 28 open fractures (35%), (Gustilo type 1, 2 and 3) while closed fractures showed soft tissue involvement of various grade (2-3 Tscherne classification). In all cases, the external fixation, sometimes associated with other reduction and synthesis techniques, was used. The timing of surgery was dictated by the condition of the soft tissues. For clinical evaluation, the Mazur score with mean follow-ups at 12 months was utilized.Results:The final range of ankle motion was 15 dorsal and 10 plantar flexion. In about 80 cases there was an average Mazur score of83. The mean score was 90;in open fractures 85 to 72. Radiographic healing of fractures in 60 patients occurred in 120 days (mean 105 days), at the time when the external fixator was removed.Conclusion:Pilon fractures are complex and often present complications;the definitive treatment, in emergency or delayed, with hybrid external fixator permits a stable synthesis with minimal soft tissue damage. Weight bearing maybe allowed early and functional recovery is generally good.

Pilon骨折中胫骨与腓骨骨折的相关性

背景:Pilon骨折的骨折线走行复杂,骨折块多粉碎,常伴有骨丢失和软组织损伤,是临床最难治疗的骨折之一。目的:分析Pilon骨折中胫骨骨折和腓骨骨折的相关性。方法:回顾性分析连云港市第二人民医院创伤骨科2014年1月至2022年1月收治的188例Pilon骨折患者的病历资料,采集患者影像学数据,包括腓骨骨折水平、腓骨骨折类型、腓骨骨折块数、胫骨位置状态、胫骨主要骨折块、胫骨内侧骨折块大小、胫骨骨折角、Topliss分型(矢状面)、Topliss分型(冠状面),将信息汇总为数据库,运用SPSS 25.0先采用斯皮尔曼相关性分析法分析Pilon骨折中胫骨与腓骨的相关数据,在相关性的基础上运用多元无序Logistic回归分析法进一步分析其相关性。结果与结论:①采用斯皮尔曼相关性分析时发现:胫骨骨折角与腓骨骨折类型、腓骨骨折水平和腓骨骨折块数呈正相关;胫骨位置状态与胫骨骨折角和Topliss分型(冠状面)呈正相关,与胫骨主要骨折块和Topliss分型(矢状面)呈负相关;腓骨骨折水平与腓骨骨折类型和腓骨骨折块数呈正相关;胫骨主要骨折块与Topliss分型(冠状面)呈正相关,与Topliss分型(矢状面)呈负相关;②采用多元无序Logistic回归分析时发现:腓骨骨折水平与腓骨骨折类型有相关性(P<0.05),腓骨骨折块数与胫骨主要骨折块有相关性(P<0.05);③提示当踝关节越倾向于外翻状态时,越容易导致腓骨骨折,且腓骨骨折水平越高,腓骨的骨折程度越严重,腓骨骨折类型越复杂,胫骨骨折角越大,胫骨越呈现Topliss分型(冠状面)骨折;④当踝关节越倾向于处于内翻或者内翻+背伸状态时,腓骨常常不骨折或出现简单骨折,且骨折水平越低,胫骨骨折角越小,胫骨越呈现Topliss分型(矢状面),胫骨主要骨折块越多,内侧骨折块越大;当踝关节处于背伸状态时,常导致腓骨简单骨折,且伴有胫骨后外侧骨折。

闭合性Pilon骨折术后下肢深静脉血栓形成的影响因素及其风险预测列线图模型构建

目的 分析影响闭合性Pilon骨折术后下肢深静脉血栓形成(DVT)的危险因素,并构建列线图预测模型。方法 2019年6月~2022年6月接受外科手术治疗的闭合性Pilon骨折病人182例,根据术后是否发生DVT分为两组,DVT组43例,非DVT组139例,采用单因素和多因素Logistic回归分析筛选影响闭合性Pilon骨折术后下肢DVT的危险因素;采用R软件构建预测闭合性Pilon骨折术后下肢DVT的列线图模型,使用受试者工作特征曲线(ROC)、校准曲线进行列线图模型验证。结果 Logistic回归分析结果显示,糖尿病史、血栓风险评估结果为中高危、手术部位发生术后感染是闭合性Pilon骨折术后下肢DVT的独立危险因素(P<0.05)。ROC曲线下面积0.716(95%CI:0.629~0.804)。校准曲线斜率接近1,且H-L拟合优度检验χ^(2)=2.556,P=0.635。结论 有糖尿病史、血栓风险评估结果为中高危、手术部位有发生术后感染是闭合性Pilon骨折术后下肢DVT的独立危险因素,整合以上3项独立危险因素构建的列线图预测模型能有效预测闭合性Pilon骨折术后下肢DVT,区分度、一致性较高。

Rock fracture under anti-plane shear (Mode Ⅲ) loading

Anti-plane punch-through shear test and anti-planefour-point bending test are used to study the crack initiation and propagation under anti-plane shear (Mode Ⅲ) loading. The tensile and shear stresses at the crack tip are calculated by finite element method. The results show that under Mode Ⅲ loading the maximum principal stress σ1 at crack tip is smaller or a little larger than the maximum shear stress τmax. Since the tensile strength of brittle rock is much lower than its shear strength, σ1 is easy to reach its critical value before τmax reaches its critical value and thus results in Mode I fracture. The fracture trajectory is helicoid and the normal direction of tangential plane with the fractured helicoid is along the predicted direction of the maximum principal stress at the notch tip. It is further proved that Mode Ⅰ instead of Mode Ⅲ fracture occurs in brittle rock under Mode Ⅲ loading. The fracture mode depending on the fracture mechanism must be distinguished from the loading form.

Treatment and clinical rehabilitation of Pilon fracture

AIM：To analyze the effect of three kinds of method on different types of Pilon fracture and advance the beat treatment plan.METHODS:From March 1989 to August 2000,107 patients were regarded as having Pilon fracture by two hospitals,among which 76 cases were followed up.They were divided into three groups according to treatment method.A group included 24 cases with the treatment of manual reduction,traction of calcaneus and plaster exopexy.B group included 30 cases with the treatment of AO key-shaped anatomical steal plate.C group included 22 cases with the treatment of limited internal fixation combined with exopexy stand.RESULTS:After 6months to 8years follow-up,it was found that three kinds of treatment methods had obvious differences on the complications and effects of different types of fracture.In A group,the excellent and good rate of treatment on I type fracture was 70%,Ⅱ type was 25%,Ⅲ type was 0%.In B group,the excellent and good rate of treatment on I type fracture was 78.6%,Ⅱ type s 87.5%,Ⅲ type was 37.5%.In C group,the excellent and good rate of treatment on I type was 75%,Ⅱ type was 80%.CONCLUSION:Summarizing kinds of factors,the treatment of A group applied in I type fracture,B group applied in Ⅱ type fracture and C group applied in Ⅲ type fracture.

Tensile and tear-type fracture toughness of gypsum material:Direct and indirect testing methods

In this context,four specimens,i.e.(i)circumferentially notched cylindrical torsion(CNCT),(ii)circum-ferentially notched cylindrical direct tension(CNCDT),(iii)edge notch disc bend(ENDB)and(iv)three-point bend beam(3PBB),were utilized to measure the modesⅠandⅢfracture toughness values of gypsum.While the CNCT specimen provides pure modeⅢloading in a direct manner,this pure mode condition is indirectly produced by the ENDB specimen.The ENDB specimen provided lower KⅢc and a non-coplanar(i.e.twisted)fracture surface compared with the CNCT specimen,which showed a planar modeⅢfracture surface.The ENDB specimen is also employed for conducting pure modeⅠ(with different crack depths)and mixed modeⅠ/Ⅲtests.KIc value was independent of the notch depth,and it was consistent with the RILEM and ASTM standard methods.But the modeⅢfracture results were highly sensitive to the notch depth.While the fracture resistance against modeⅢwas significantly lower than that of modeⅠ,the greater work of fracture under modeⅢwas noticeable.

The damage control in tibial pilon open fractures with a new external fixator delta frame

Objective: To evaluate the effectiveness of the damage control, in emergency to treat the open tibial pilon fractures with Dolphix? External Fixator Frame(CITIEFFE?, Calderara di Reno, Bologna, Italy). Methods: From January 2017 to August 2017, at the Department of Orthopedics and Traumatology of Vito Fazzi Hospital Lecce, we treated 23 open tibial pilon fractures with Dolphix? External Fixator Frame(CITIEFFE?, Calderara di Reno, Bologna, Italy). The evaluation criteria of the case series were: the time needed to assemble the external fixator;the time taked to treat the ankle associated lesions;the time of skin healing;the ankle alignment;the subjective/objective Ovadia and Beals score;and complications. The Endpoint assessment was set at the days of the definitive surgery. Results: The results in terms of alignment, biomechanical stability of the frame, healing of soft tissue, complications were as good as the objective and subjective results according Ovadia and Beals score. Conclusion:Pilon fractures are complex and often present complications;the damage control treatment, in emergency, with Dolphix? External Fixator Frame(CITIEFFE?, Calderara di Reno, Bologna, Italy) permits a stable osteotaxis with minimal soft tissue damage and permit the repair of muscles, blood vessels and nerves with a stable bone and the soft tissue healing with vaccum therapy.

一期前后联合入路治疗复杂Pilon骨折的效果观察

目的观察一期后外侧入路联合前正中入路(一次性完成手术操作)治疗复杂Pilon骨折的可行性及效果。方法回顾性选取河南省中医院急救创伤中心骨伤病科2016年9月至2019年11月收治的9例复杂Pilon骨折患者,均在适当准备后经后外侧入路联合前正中入路一次性完成手术操作,随访观察疗效。结果术后3个月进行Burwell-Charnley影像学评价,结果为优7例,良2例,差0例。以各自最后一次随访时美国矫形足踝协会(AOFAS)踝-后足评分为计,优5例,良3例,中1例,差0例。骨折复位及踝关节功能恢复满意。结论经过适当准备,选择合适的病例,复杂Pilon骨折可选择一期前后联合入路方案且优势明显。

L型胫骨远端前外侧钢板在Pilon骨折中的应用

目的研究L型胫骨远端前外侧钢板应用于Pilon骨折患者临床治疗中的疗效。方法随机选取2020年1月—2023年1月玉门市第一人民医院收治的50例Pilon骨折患者作为研究对象,根据手术方案分为两组,每组25例,对照组接受内侧入路普通钢板固定治疗,观察组应用L型胫骨远端前外侧钢板治疗。比较两组踝关节功能改善情况、应激指标水平变化情况、手术指标、并发症发生情况。结果观察组踝关节功能改善情况优于对照组,差异有统计学意义(Z=2.038,P<0.05)。观察组手术时间、术后首次下床时间、骨折愈合时间均短于对照组,差异有统计学意义(P均<0.05)。观察组术后C反应蛋白(C-reactive protein,CRP)、前列腺素E2(prostaglandin E2,PGE2)水平均低于对照组,超氧化物歧化酶(superoxide dismutase,SOD)水平高于对照组,差异有统计学意义(P均<0.05)。观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论L型胫骨远端前外侧钢板于Pilon骨折患者中应用所获疗效满意,可有效改善患者的踝关节功能,且治疗所致应激损伤较小。

The treatment of severe open Pilon fractures

Objective To discuss the operative methods,timing and outcomes of severe open Pilon fractures.Methods From April 2003 to July 2008,21 patients with open Pilon fractures were admitted.All the patients were type C fracture according to

股骨颈动力交叉钉系统治疗中青年PauwelsⅡ型Ⅲ型股骨颈骨折的临床价值分析

目的探究股骨颈动力交叉钉系统治疗中青年PauwelsⅡ型Ⅲ型股骨颈骨折的临床价值。方法随机选取2020年1月—2022年7月于三明市中西医结合医院接受治疗的155例中青年PauwelsⅡ型Ⅲ型股骨颈骨折患者为研究对象,通过随机数表法分为对照组(n=80)及治疗组(n=75),分别行空心螺钉内固定治疗、股骨颈动力交叉钉系统。对临床指标、并发症发生情况展开观察。结果两组患者住院时间对比,差异无统计学意义(P>0.05)。治疗组手术时间[(45.57±4.44)min]短于对照组、骨折愈合时间[(3.61±0.87)个月]早于对照组、Harris髋关节功能评分[(92.49±5.51)分]高于对照组、股骨颈缩短长度[(4.91±1.05)mm]短于对照组,差异有统计学意义(t=38.498、5.657、4.304、7.786,P均<0.05)。对照组术中出血量[(17.32±5.21)mL]少于治疗组、切口总长度[(3.51±0.82)cm]短于治疗组,差异有统计学意义(t=11.380、6.032,P均<0.05)。治疗组并发症发生率(2.67%)低于对照组,差异有统计学意义(χ^(2)=4.326,P<0.05)。结论空心螺钉内固定治疗以及股骨颈动力交叉钉系统治疗中青年PauwelsⅡ型Ⅲ型股骨颈骨折在住院时间不具有明显差异,空心螺钉内固定术可减少患者术中出血量并缩短切口总长度,而股骨颈动力交叉钉系统则可缩短手术时间、骨折愈合时间、股骨颈缩短长度、提高Harris评分、降低并发症发生率。

外固定支架联合有限内固定治疗Rüedi-Allgower Ⅲ型胫骨Pilon骨折的临床疗效分析以及经验初探

目的研究比较两种内固定方式治疗Rüedi-Allg?werⅢ型胫骨Pilon骨折的临床疗效,总结个人对于复杂性胫骨Pilon骨折的经验。方法选取2011年3月至2015月6月收治的32例Rüedi-Allg?werⅢ型胫骨Pilon骨折患者作为研究对象。按照数字单双号分为观察组和对照组,每组16例。观察组患者给予外固定支架联合有限内固定治疗,对照组患者给予切开复位内固定治疗。比较两组患者的手术相关指标、临床踝关节复位情况和术后3个月并发症发生率。结果 (1)手术相关指标方面:两组患者手术时间、骨折愈合时间比较差异无显著性,但观察组术中出血量明显优于对照组,差异均具有统计学意义(P<0.05)。(2)Mazur评分情况:观察组患者Mazur评分为优良者的比率87.5%(14/16)均明显高于对照组75.0%(12/16),差异具有统计学意义(P<0.05)。(3)观察组患者术后并发症发生率为12.5%(2/16),低于对照组的并发症发生率25.0%(4/16),差异有统计学意义(P<0.05)。结论与切开复位内固定相比较,外固定支架联合有限内固定治疗Rüedi-Allg?werⅢ型胫骨Pilon骨折效果更好,复位效果好,术后恢复快,并发症发生率低,值得临床推广应用。

不同钢板内固定治疗Ruedi-Allgower Ⅱ、Ⅲ型闭合性胫骨Pilon骨折的临床疗效比较研究

目的研究分析不同钢板内固定治疗Ruedi-AllgowerⅡ、Ⅲ型闭合性胫骨Pilon骨折的临床疗效及不良反应情况。方法选取2010年1月-2015年1月哈尔滨医科大学附属第一医院骨外科收治闭合性胫骨Pilon骨折患者54例。治疗医师根据患者手术内固定物的不同将所有患者分为两组，A组行LCP内固定治疗，B组行解剖钢板内固定治疗，观察两组患者手术时间、术中出血量、住院时间、下地患肢无负重练习时间、骨折愈合时间、末次随访临床效果评定及不良反应情况。结果治疗医师通过门诊复查对两组患者行8-16个月随访，平均随访时间11．35±2．25个月。A组患者的手术平均时间、骨折愈合平均时间显著少于B组，差异具有统计学意义（P〈0．05）；两组的术中平均出血量、住院平均时间、下地患肢无负重练习平均时间比较差异无统计学意义（P〉0．05）；两组患者术后末次随访AOFAS踝-后足评分结果显示，A组术后末次随访AOFAS踝-后足评分优良率略高于B组，差异具有统计学意义（P〈0．05）；A组不良反应发生率显著低于B组，差异具有统计学意义（P〈0．05）。两组术后末次随访的骨折影像学复位评估，A组23例解剖复位，3例部分复位，1例复位较差；B组22例解剖复位，3例部分复位，2例复位较差，两组的各种复位患者比率差异无统计学意义（P〉0．05）。结论锁定钢板内固定治疗Ruedi-AllgowerⅡ、Ⅲ型闭合性胫骨Pilon骨折临床疗效更佳，在降低手术创伤的同时，关节面恢复、骨折端稳固固定更好，术后不良反应发生率更低，适合临床推广应用。

Ⅱ～Ⅲ型Pilon骨折治疗与影响疗效因素分析

[目的]探讨高能量Pilon骨折治疗方法与影响疗效相关因素分析。[方法]对24例Ⅱ～Ⅲ型Pilon骨折(R櫣edi-Allgower分型:Ⅱ型14例,Ⅲ型10例)采取切开复位钢板内固定,其中10例辅以外固定,16例予以植骨修补骨缺损,其中自体松质骨填塞10例,大块髂骨植入6例。[结果]自2003年6月～2007年12月,采用Burwell-Charnley系统进行骨折复位评分,优16例,良8例;踝关节功能Mazur评分,优12例,良10例,可2例。[结论]在治疗Ⅱ～Ⅲ型Pilon骨折时,大块髂骨植骨能有效解决严重骨缺损、提高内固定稳定性,使关节早期活动,有利功能恢复。

前外侧入路治疗RuediⅡ-Ⅲ型Pilon骨折

目的:探讨前外侧入路治疗严重Pilon骨折的疗效。方法:2002年2月至2008年3月,采用前外侧入路治疗的RuediⅡ-Ⅲ型Pilon骨折63例,男36例,女27例;年龄19～71岁,平均37岁。受伤至治疗时间为2h～19d,平均8d。按Ruedi分型:Ⅱ型32例(合并局部软组织挫裂伤6例,其中4例为开放骨折),Ⅲ型31例(合并局部软组织挫裂伤9例,其中8例为开放骨折)。术后观察创面愈合情况、骨感染、骨不连、骨折畸形、踝关节活动度及疼痛程度,评价手术疗效。结果:4例患者创面不愈合,经过植皮或皮瓣覆盖创面愈合,5例因骨不连超关节固定时间长,导致踝僵硬活动受限。所有患者获得随访,时间8～31个月,平均15.3个月。骨愈合时间8～14周,平均10周。按Helfet疗效评价标准:优28例,良30例,差5例。结论:采用前外侧入路治疗RuediⅡ-Ⅲ型Pilon骨折能取得满意的治疗效果,可有效避免并发症的发生。

PilonⅢ型骨折的关节面修复重建

目的对PilonⅢ型骨折关节面修复与重建的手术方法及经验进行总结。方法1999年1月～2005年12月,收治PilonⅢ型骨折20例22侧,其中资料完整者16例18侧。男13例15侧,女3例3侧;年龄14～48岁。坠落伤12例14侧,交通伤4例4侧。采用延期切开复位内固定,以距骨关节面为模板对胫骨远端平台关节面准确复位、坚实植骨、坚强内固定、早期功能锻炼的方法进行治疗。结果术后切口Ⅰ期愈合14侧,延迟愈合3侧,感染1侧。所有患者获随访9～71个月,平均22个月。X线片复查示内固定物无进入关节腔者。依据Teeny等提出的Pilon骨折术后放射学评价标准,关节面解剖复位率77.8%(14/18)。骨折Ⅰ期愈合率94.4%(17/18)。根据Mazur等制定的踝关节症状与功能评分系统对18侧手术关节进行功能评估,优5侧,良7侧,可5侧,差1侧,优良率66.7%。结论软组织正确处理、胫骨远端平台高度的良好恢复、关节面准确复位及充分植骨为关节面提供坚实的即时支撑,坚强内固定稳定维持胫骨远端正常形态和早期功能锻炼是手术成功的关键。