分阶段延期切开复位内固定治疗严重pilon骨折  

Two-staged open reduction and internal fixation for pilon fractures of types Ⅱ and Ⅲ

作　　者：黄雷[1] 张峰[1] 叶鹏翰[1] 何贤峰[1] 阮永平[1] 徐荣明[1] 

机构地区：[1]浙江省宁波市第六人民医院骨科,315040

出　　处：《中华创伤骨科杂志》2009年第11期1039-1041,共3页Chinese Journal of Orthopaedic Trauma

摘　　要：目的评估分阶段延期切开复位内固定治疗严重pilon骨折的临床疗效。方法2003年12月至2008年2月收治23例高能量损伤pilon骨折患者，根据Rtiedi—AllgSwer分型：Ⅱ型9例，Ⅲ型14例。所有患者急诊行腓骨切开复位内固定，内侧超踝关节支架临时外固定。7～10d（平均8d）后拆除外固定支架，行胫骨远端骨折切开复位内固定。结果所有患者均获得随访，时间13～34个月，平均25个月。骨折愈合时间8～30周，平均18周，按照Teeny和Wiss等踝关节功能评分系统评分：优13例，良7例，可2例，差1例，优良率为86．9％。2例术后出现局部软组织并发症，包括1例皮肤坏死，1例切口浅表感染，通过换药后治愈。结论分阶段治疗严重pilon骨折能有效降低软组织并发症，提高关节面的复位质量。Objective To evaluate the two-staged treatment of types Ⅱ and Ⅲ pilon fractures. Methods From December 2003 to February 2008, 23 severe cases of pilon fractures underwent emergent fibular fixation and medial spanning external fixation. According to the Rtiedi-Allgower classification, there were 9 cases of type Ⅱ, and 14 type Ⅲ. After the external fixation for 7 to 10 days （average, 8 days）, the fixators were removed and the patients underwent open reduction and internal plating. Results All patients were available for an average follow-up of 25 months （range, 13 to 34） after surgery. All fractures healed at an average of 18 weeks （range, 8 to 30） postoperatively. There were 13 excellent cases, 7 good, 2 fair, and 1 poor according to the ankle scoring of Teen and Wiss. The complications included skin necrosis in 1 case and wound superficial infection in 1 case, which were successfully treated by local changes of dressing. Conclusion The two-stage treatment protocol for severe pilon fractures can decrease soft tissue complications and improve articular anatomical reconstruction.

关 键 词：胫骨骨折 骨折固定术 

分 类 号：R686[医药卫生—骨科学]