Pilon骨折合并同侧跟骨骨折的治疗  

Management of ipsilateral Pilon and calcaneal fractures

作　　者：王敬博[1] 万春友[1] 李宝和[1] 卢艳东[1] 姚辉[1] 

机构地区：[1]天津医院综合创伤科,天津300211

出　　处：《中华创伤杂志》2008年第11期877-880,共4页Chinese Journal of Trauma

摘　　要：目的探讨Pilon骨折合并同侧跟骨骨折的治疗方法。方法本组坠落伤7例，交通伤2例，重物砸伤1例，ISS评分为5～22分。开放性损伤7例，闭合性损伤3例。9例骨折达AO／OTA各分型中的2～3度，6例跟骨为关节内塌陷粉碎骨折。6例Pilon骨折行切开复位空心钉、螺钉或克氏针固定，其中4例加外固定架固定，跟骨骨折行撬拨复位克氏针或空心钉固定；2例单纯行跟骨骨折克氏针固定，2例两处骨折保守治疗。结果6例胫骨远端和跟骨骨折手术治疗者骨折对位改善；保守治疗者出现骨折成角畸形，关节面塌陷。7例伤口愈合良好，3例软组织愈合不良。4例随访患者踝一后足评分为82～94分。结论Pilon骨折合并同侧跟骨骨折为高能量暴力所致，局部软组织及骨组织损伤严重，有限内固定加外固定是比较适宜的治疗选择。Objective To analyze treatment of ipsilaterai Pilon and caicaneal fractures （IPCF）. Methods Injury causes included failings in seven patients, traffic injury in two and impact injury in one, with ISS score of 5-22 points. There were seven patients with open injuries and 3 with close ones. Nine pa- tients had Ⅱ-Ⅲ degree of Pilon fractures according to the AO/OTA classification and six comminuted com- pression calcaneai fractures according to the Essex-Loprest classification. The Pilon fractures were fixed by cannulated nail, screw or Kirschner wire through open reduction in six patients including four fixed with external fixators （the calcaneal fractures were fixed with percutaneous cannulated nail or Kirschner wire by poking reduction）. The caicaneai fractures were fixed with only Kirschner wire through poking reduction in two patients and double fractures treated conservatively in two. Results The reduction of Pilon and calcaneai fractures treated by operation were markedly improved in six patients, while there occurred angular deformity and joint surface introcession in the patients treated conservatively. The wound healing of soft tissue was sound in seven patients but unsatisfactory in the other three. The ankle-hind foot score was 82-94 points in four patients who were followed up. Conclusions IPCF is caused by the high energy force and characterized by severe injures of the soft tissues and the bone tissues at the distal tibia and calcaneus, for which limited internal fixation plus external fixation are suitable treatment choice.

关 键 词：胫骨骨折 跟骨 骨折固定术 撬拨复位术 

分 类 号：R687.3[医药卫生—骨科学]