个体化与分级治疗高能量创伤性Pilon骨折  

Clinical analysis of Pilon fracture with individual management

作　　者：沈波[1] 黄伟杰[1] 吴伟[1] 倪纲[1] 洪城[1] 王世银[1] 

机构地区：[1]上海市浦南医院骨科,200125

出　　处：《中国矫形外科杂志》2010年第14期1150-1152,共3页Orthopedic Journal of China

摘　　要：[目的]根据软组织损伤分级制定高能量创伤性Pilon骨折的个体化治疗方案,探讨其临床疗效。[方法] 2005年1月～2008年9月手术治疗Pilon骨折29例;男22例,女7例;年龄23～63岁,平均41.4岁。根据Ruedi-Allgower骨折分型:Ⅱ型16例,Ⅲ型13例。参照Tscherne-Gotzen软组织分度:闭合性骨折22例,软组织0度损伤的8例、1度4例、2度8例、3度2例;开放性骨折7例,软组织1度损伤3例、2度2例、3度2例。根据软组织损伤分级制定个体化治疗方案,分别采用延期切开复位内固定治疗、分阶段治疗及外支架固定治疗。[结果]全部病例均获得随访,随访时间12～56个月,平均28.6个月。按照Mazur等评分系统进行评估:优10例,良13例,可4例,差2例,优良率为79.3%。5例(17.2%)术后出现软组织并发症,包括2例切口感染、1例切口周缘皮肤坏死、1例深部感染、1例外支架钉道感染。[结论]根据软组织损伤分级制定个体化治疗方案,能有效的减少局部并发症并获得较好的踝关节功能。[Objective]To analyze the results of distal tibial pilon fractures treated with individual management based on severity of soft tissue injury.[Method]From January 2005 to September 2008,29 Pilon fractures were treated.There were 22 males and 7 females aging from 23 to 63,with an average of 41.4.According to Ruedi-Allgower classification system of Pilon fracture,16 cases were type Ⅱ,13 type Ⅲ.According to Tscherne-Gotzen graduation system of soft tissue injury,22 cases were close fracture,8 grade 0,4 grade 1,8 grade 2,2 grade 3,and 7 cases were open fracture,3 grade 1,2 grade 2,2 grade 3.Individual management was based on severity of soft tissue injury.[Result]All patients were available for follow-up at an average of 28.6 months（range,12 to 56 months） after surgery.There were 10 excellent,13 good,4 fair,and 2 poor results according to the ankle score of Mazur.The complications occurred in 5 patients（17.2%）,including wound superficial infection（n=2）,skin necrosis（n=1）,deep infection（n=1）,and pin tract infection（n=1） with external fixation.[Conclusion]Individual management based on severity of soft tissue injury for Pilon fracture has advantages of fewer complications and good function.

关 键 词：胫骨骨折 骨折固定术 个体化 

分 类 号：R687.3[医药卫生—骨科学]