分步延期切开复位内固定治疗Pilon骨折的疗效分析  

Therapeutic effect of two-stage delayed open reduction and internal fixation on Pilon fracture

作　　者：潘峰[1] 陶海鹰[1] 

机构地区：[1]武汉大学人民医院骨科,武汉430060

出　　处：《解放军医学杂志》2009年第10期1237-1238,1243,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的观察分步延期切开复位内固定治疗Pilon骨折的临床疗效。方法回顾性分析2001年1月-2006年10月收治的36例单侧Pilon骨折患者的临床资料。36例患者中男26例,女10例;年龄18～57岁,平均38.5岁;开放性骨折9例,闭合性骨折27例,合并腓骨骨折25例;Ruedi-Allgower分型Ⅰ型6例,Ⅱ型21例,Ⅲ型9例。予跟骨牵引或石膏托行骨折临时固定7～14d,平均9.8d,待局部软组织损伤恢复后再行切开复位内固定治疗。对踝关节功能进行评定并记录术后并发症发生情况。结果术后随访19～34个月,平均28个月。根据Mazur评分系统评定,踝关节功能优13例,良17例,可4例,差2例,优良率83.3%。术后并发症包括切口表浅感染2例,切口皮缘坏死2例,关节退行性变19例。结论Pilon骨折行分步延期切开复位内固定治疗术后局部软组织并发症少,长期随访踝关节功能优良。Objective To investigate the therapeutic effect of two-stage delayed open reduction and internal fixation on Pilon fractures.Methods The clinical data of 36 patients（26 males and 10 females;aged 18-57 years with a mean of 38.5 years;9 patients suffered from open fractures and 27 with closed fractures;25 combined with fibular fractures） with monolateral Pilon fracture hospitalized in succession from Jan.2001 to Oct.2006 were analyzed retrospectively.According to the Ruedi-Allgower classification,there were 6 cases with type Ⅰ,21 with type Ⅱ and 9 with type Ⅲ fracture.All patients underwent temporary fixation with calcaneal traction or plaster slab for 7 to 14 days（mean 9.8d）,and then they were treated with delayed surgery when the soft tissue injuries subsided.Ankle functions were evaluated to assess the clinical outcomes,and complications were documented for further analysis.Results Follow-up was performed for 19 to 34 months（in mean of 28 months）.Based on the Mazur classification,the ankle function in 13 cases was excellent,17 as good,4 as fair and 2 as poor,with a satisfactory rate of 83.3%.Postoperative complications included 2 cases of superficial incision infections,2 of skin slough and 19 of articular degeneration.Conclusion Two-stage delayed open reduction and internal fixation is a reasonable and effective procedure in treating Pilon fractures with advantages of few complications and satisfactory ankle function.

关 键 词：胫骨骨折 骨折固定术 内 治疗结果 手术后并发症 

分 类 号：R683.423[医药卫生—骨科学]