手法整复结合有限手术治疗Pilon骨折49例分析  

Analysis of 49 cases with Tibia Pilon Fractures Treated by Manipulation and Limited Operation

作　　者：陈兆军[1] 江军[1] 安国民[1] 于益民[2] 牛永利 

机构地区：[1]北京中医药大学第三附属医院,北京100020 [2]山东省滨州市人民医院 [3]保定博惠骨病医院

出　　处：《中国中医骨伤科杂志》2009年第6期15-17,共3页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:探讨手法整复结合有限手术治疗Pilon骨折的临床疗效。方法:自1999年5月～2005年9月治疗Pilon骨折病人68例,随访49例,男35例,女14例;平均年龄39.6岁;开放骨折18例,闭合骨折31例。其中42例有腓骨骨折,手术固定39例;根据Ruedi-Allgower分型:Ⅰ型8例,Ⅱ型26例,Ⅲ型15例。治疗方法:18例开放骨折病例,急诊淸创后行中医手法复位,空心拉力螺钉固定6例,钢板固定6例,外固定支架固定6例。31例闭合骨折病例,行手法闭合复位,石膏外固定5例,克氏针内固定后辅以石膏外固定3例,空心拉力螺钉固定14例;有限手术切开复位钢板螺钉固定9例。综合进行踝关节功能评分。结果:本组49例,随访最短者6个月,最长者6年,平均3.9年。疗效评定参照Teeny等的踝关节功能评分标准,进行功能评分:优18例,良23例,可6例,差2例,优良率为83.7%。结论:Pilon骨折通过手法整复结合有限手术治疗临床疗效满意,但手术时机值得商榷,不一定必须急诊手术。Objective：To study the results of manipulation and limited operation treatment for tibial Pilon fractures. Methods：From May 1999 to September 2005, 68 patients with Pilon fractures were treated and 49 cases of them were followed up, including 35 males and 14 females, who averagely aged 39.6 years. Among them, 18 had open fractures, 31 had closed fractures, 42 cases had fibular fractures, and 39 received fixation. According to the Ruedi--Allgower classification, 8 cases were type Ⅰ fracture, 26 were type Ⅱfracture and 15 were type Ⅲ fracture. The treatment methods were as follows： 18 cases of open fracture were given technique of TCM close diaplasis after debridement in emergency, then 6 with tensile screw fixation, 6 with plate fixation and 6 with external fixation; 31 cases of closed fracture received close diaplasis, then 5 with gypsum fixation, 3 with kirshner wire plus gypsum fixation, 14 with tensile screw fixation, and 9 with limited operation open reduction plus screws and plate fixation. Comprehensive evaluations of the ankle functions were made. Results： The follow--up ranged from 6 months to 6 years, averagely 3.9 years. According to Teeny＇s criteria, the curative effects were evaluated as excellent in 18 cases, good in 23, fair in 6 and poor in 2. The excellent and good rate was 83.7%. Conclusion：The combination of TCM technique and limited operation for tibial Pilon fracture is satisfying, which means emergency operation is not always a must. But the choice of operation time should be given more consideration.

关 键 词：PILON骨折 骨折固定术 手法整复 有限手术 

分 类 号：R274.12[医药卫生—中医骨伤科学]