Pilon骨折患者的手术治疗  

The surgical operation of tibia pilon fractures

作　　者：于益民[1] 陈兆军 王学华[1] 孙磊[1] 

机构地区：[1]山东省滨州市人民医院骨科,256610 [2]北京足踝外科研究所,100082

出　　处：《河北医药》2005年第5期338-339,共2页Hebei Medical Journal

摘　　要：目的探讨手术治疗Pilon骨折的临床疗效.方法 1999年5月至2003年9月收治Pilon骨折患者38例,随访29例,其中男25例,女4例;年龄17～62岁,平均35.6岁.开放骨折8例,闭合骨折21例,其中有腓骨骨折24例;根据Ruedi-Allgower分型:Ⅰ型3例,Ⅱ型16例,Ⅲ型10例.8例开放骨折患者,均急诊行清创复位内固定术,拉力螺钉固定外加石膏固定3例,普通钢板固定2例,骨外固定架固定3例.闭合骨折21例,行拉力螺钉固定11例,行克氏针内固定后辅以石膏固定3例,行解剖钢板固定5例,行加压钢板固定2例.急诊进行手术19例,10～16 d后手术10例.综合进行踝关节功能评分.结果本组29例,随访最短者6个月,最长者4年,平均2.9年.疗效评分参照Teeny等的踝关节功能评分标准,进行功能评分:优11例,良13例,可3例,差2例,优良率为82.8%.结论手术治疗Pilon骨折的临床疗效满意,但并不一定必须急诊手术.Objective To observe the therapeutic effect of surgical operation on tibia pilon fractures.Methods Among 39 patients with pilon fractures who were admitted from May 1999 to September 2003,29 cases were followed up (25 males,4 females,age range:17～62 yr,average age:35.6 years),8 cases with open fracture,21 cases with closed fracture,including 24 cases of fibula fracture.According to the Ruedi-Allgower classification,there were 3 cases of type Ⅰ fracture,16 cases of type Ⅱ fracture and 10 cases of type Ⅲ fracture.8 patients with open fracture were treated urgently with diaplasis and internal fixation after debridement,of which 3 cases were treated with tensile screws and gypsum,2 cases were fixed with normal plate,3 cases were stabilized by unilateral external fixation.Among 21 patients with closed fracture,11 cases were treated with tensile screws,3 cases with steeliness acus and gypsum,5 cases with anatomical plate and 2 cases with stress plate.19 patients were operated urgently,10 cases were operated within 10 to 16 days after injury.The final outcomes of treatment were evaluated based on the ankle score of Teeny and Wiss.Results 29 cases were available for follow-up (range:6 months-4 years,average time:2.9 years) after surgical operation.According to the ankle score of Teeny and Wiss,11 cases were excellent,13 cases good,3 cases fair,and 2 cases poor results (excellent rate 82.8%).Conclusion The results of surgical operation on tibia pilon fractures is satisfactory,however,the fractures are not always urgently needed to be treated surgically.

关 键 词：PILON骨折 外科手术 治疗 开放骨折 闭合骨折 

分 类 号：R683.42[医药卫生—骨科学]