两种术式治疗Pilon骨折的比较  

Two different ways of treatment to Pilon fractures

作　　者：郭震[1] 姚勐炜[1] 杨安礼[1] 

机构地区：[1]上海市杨浦区中心医院骨科,上海200090

出　　处：《临床骨科杂志》2011年第2期182-184,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨外固定支架配合有限切开内固定治疗Pilon骨折的疗效和安全性。方法将55例Pilon骨折患者根据治疗方法分成两组：A组（28例）为有限切开复位内固定加外固定支架治疗;B组（27例）采用克氏针张力带配合石膏外固定、切开复位内固定、手法复位石膏固定、跟骨牵引等其他方法。对患者手术前后X线片、并发症、骨折愈合时间、临床疗效等指标进行比较。结果两组均获8-24个月随访。A组骨折愈合时间（2.5±1.8）个月;B组骨折愈合时间（2.7±1.7）个月,两组比较差异无统计学意义（P〉0.05）。临床疗效按Helfet标准评定：A组：优8例,良12例,差8例;B组优7例,良12例,差8例,两组比较差异无统计学意义（P〉0.05）。并发症为伤口愈合不良或局部皮肤坏死：A组5例（18%）,B组9例（33%）,两组比较差异有统计学意义（P〈0.05）。结论复杂Pilon骨折选择外固定支架结合有限切开内固定治疗是较好的选择,可以减少术后并发症的发生,有较高的实用性和安全性。Objective To discuss the efficacy and safety of limited open reduction and internal fixation combined with external fixation to Pilon fractures.Methods According to different ways of treatment to Pilon fractures,55 patients were divided into two groups：28 patients were treated with limited open reduction internal fixation combined with external fixation as group A and 27 patients were treated with other methods as group B,including Kirschner wire tension band internal fixation with plaster immobilization,open reduction and internal fixation,closed reduction and plaster immobilization,and skeletal traction.X-ray of preoperative and postoperative,fracture healing time were recorded.Results In group A 28 cases were followed up for 8~24 months,average fracture healing time（2.5±1.8）months.In group B 27 cases were followed up for 8~24 months,average fracture healing time（2.7±1.7）months.No difference between them（P0.05）.According to Helfet evaluation criteria,Group A： excellent 8 cases,good 12 cases,poor 8 cases.Group B： excellent 7 cases,good 12 cases,poor 8 cases.No difference between them was found（P0.05）.In group A there were 5 cases with wound healing bad or local skin necrosis compare with 9 cases in group B.There was significant difference between them（18% vs 33%,P0.05）.Conclusions The treatment with external fixation,limited open-reduction and internal fixation for tibia Pilon fractures is effective and safe.

关 键 词：Pilon骨折:踝损伤 外固定器 有限切开 骨折固定术 内 

分 类 号：R683.42[医药卫生—骨科学] R687.32[医药卫生—外科学]