延期切开复位内固定加植骨治疗严重Pilon骨折  

Treatment of severe Pilon fracture with delayed open reduction and internal fixation plus bone graft

作　　者：赵友明[1] 郭晓山[1] 宋永焕[1] 王振文[1] 洪汝康[1] 陈华[1] 

机构地区：[1]温州医学院附属第二医院骨科,325027

出　　处：《中华创伤杂志》2007年第9期689-691,共3页Chinese Journal of Trauma

摘　　要：目的探讨延期切开复位内固定加植骨治疗严重Pilon骨折的临床疗效。方法对15例严重Pilon骨折（Ruedi—Allgower分型Ⅲ型）患者全部采用延期切开复位内固定加植骨（自体髂骨或同种异体骨）治疗，术后行石膏托外固定6～8周。结果所有患者术后获10～48个月（平均25，3个月）的随访，骨折均获骨性愈合，骨折愈合平均时间为4．8个月。踝关节功能按Mazur等的评分标准，优7例，良5例，可2例，差1例，优良率为蜘％。结论对严重的Pilon骨折延期切开复位内固定加植骨是一种行之有效的方法，术前应严格评估软组织损伤程度，术中正确选择手术入路，恢复关节面的平整性，对骨折端予以坚强稳定的内固定，坚持生物学固定的原则，骨缺损区应足量植骨，避免术后发生Ⅱ期塌陷。Objective To explore the clinical effects of delayed open reduction and internal fixation plus bone graft on severe Pilon fracture. Methods A total of 15 patients with severe type Ⅲ Pilon fracture by Ruedi-Allgower classification were surgically treated with delayed open reduction and internal fixation plus bone transplantation, and with plaster external fixation for 6-8 weeks after operation. Results The patients were followed up for 10-48 months （average 25.3 months）. Bone union was achieved in all patients, with duration of union for average 4.8 months. By the Mazur ankle evaluation grading system, 7 cases were graded as excellent, 5 good, 2 fair and 1 poor, with an excellence rate of 80%. Conclusions Delayed open reduction and internal fixation plus bone transplantation is proved effective for severe Pilon fracture. Attention should be paid to the strict evaluation of articular surface condition before operation, rigid internal fixation of the fractured bone, biological fixation, enough bone graft transplanted into the areas of bone defects to avoid secondary compression.

关 键 词：胫骨骨折 骨折固定术 内 骨移植 

分 类 号：R686[医药卫生—骨科学]