有限内固定结合外固定支架治疗高能量Pilon骨折  

Limited Internal Fixation Combined with External Fixator for High Energy Pilon Fracture

作　　者：罗从风[1] 于晓雯[1] 蒋建新[1] 何鹤皋[1] 于仲嘉[1] 

机构地区：[1]上海市第六人民医院骨科

出　　处：《中华骨科杂志》1998年第10期584-586,共3页Chinese Journal of Orthopaedics

摘　　要：目的：介绍应用有限内固定结合外固定支架治疗１９例高能量Ｐｉｌｏｎ骨折的经验，并对本方法的治疗结果进行评估。方法：１９９３～１９９６年间有１９例患者接受该方法治疗，其中男性１４例，女性５例，致伤原因以高空坠落伤及车祸为主。该手术采用踝正中切口，暴露胫骨远端关节面，以螺钉或克氏针固定，“Ｔ”型单侧多功能外固定支架的近侧螺钉置于胫骨骨折近端，远侧螺钉置于跟骨上，术后每天放松远侧万向关节两次，活动踝关节。结果：术后有１６例获得优良关节面复位（８４．２％），１７例肢体力线恢复良好（８９．４％）。临床评分（Ｐｈｉｌｉｐｓ＆Ｓｈｗａｒｔ踝关节评分）５５～９２分（平均为７６分），随访时间１２～３８个月（平均２９个月）。结论：有限内固定结合外固定支架治疗Ｐｉｌｏｎ骨折有效地避免了伤口并发症及骨不连，更好地恢复关节面的解剖，且固定更为确切、牢固，有利于恢复关节间隙及关节活动恢复正常，是治疗高能量Ｐｉｌｏｎ骨折（Ⅲ、Ⅳ、Ⅴ型）较好的方法。Objective:To describe the experience of limited internal fixation combined with external fixator for high energy Pilon fracture and to evaluate the outcome.Materials and Methods:From Apr.1993 to Jun.1996,19 patients (14 men and 5 women) sufferd from high energy Pilon fracture were treated with this method.The main injury was caused by high altitude dropping and traffic accident.Incision was made through an medial approach,the distal articular surface of tibia was exposed and then the fracture fragments were fixed with screw and Kirschner wire.Proximal pins of“T”pattern unilateral multifunctional external fixator were placed into the proximal portion of fracture line and the distal pins placed into the calcaneus.Postoperatively,ankle joint exercised two times every day by relaxing the multi-directional joint of the external fixator.Results:Postoperatively,16 cases (84.2%) got good and excellent reduction of articular surface and 17 cases (89.4%) had satis factory limb alignment.According to Phillips & Shwart ankle joint scoring scale system,the final result was scored from 55 to 92 (average 76).Conclusion:This method could avoid wound complications and nonunion sufficiently,with advantage of restoring anatomical articular surface,joint space and joint activity effectively and firm fixation.The authors considered that limited internal fixation combined with external fixator is a satisfactory method of treatment for high energy Pilon fracture.

关 键 词：胫骨骨折 外固定器 PILON骨折 内固定 

分 类 号：R683.420.5[医药卫生—骨科学]