经皮撬拨复位在Ⅱ、Ⅲ型Pilon骨折复位中的意义  

The role of poking reduction in the treatment of type Ⅱ,Ⅲ Pilon fractures

作　　者：张静波[1] 徐锋[1] 孙斌峰[1] 吴晓峰[1] 钱红兵[1] 张伟刚[1] 姜兴华[1] 董燚[1] 张志明[2] 

机构地区：[1]昆山市中医医院骨科,江苏昆山215300 [2]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《临床骨科杂志》2013年第6期697-699,共3页Journal of Clinical Orthopaedics

基　　金：江苏省自然科学基金(编号:BK2011264);昆山市社会发展项目(编号:KS2011652)

摘　　要：目的探讨经皮撬拨复位在内固定治疗Ⅱ、Ⅲ型Pilon骨折的临床意义。方法选取54例Ruedi-AllgowerⅡ、Ⅲ型Pilon骨折患者,随机分为2组:A组29例,采用自行研制的骨撬拨器经皮对骨折撬拔复位后行切开内固定;B组25例,采用切开直视复位内固定术。以Mazur标准评判术后踝关节功能。结果手术时间:A组1.5～3.0(2.4±0.3)h,B组2.0～3.5(2.8±0.4)h,差异有统计学意义(P<0.05)。随访18～36(24.3±6.4)个月,骨折均一期愈合。A组骨折愈合时间为12～16(13.4±3.4)周,踝关节功能优15例,良9例,中3例,差2例,优良率24/29;B组骨折愈合时间12～18(15.2±3.5)周,踝关节功能优13例,良6例,中4例,差2例,优良率19/25;两组骨折愈合时间、踝关节功能优良率比较差异均有统计学意义(P<0.05)。A组3例、B组6例术后出现皮肤坏死、踝关节功能障碍,两组差异有统计学意义(P<0.05)。结论采用撬拨复位Ⅱ、Ⅲ型Pilon骨折操作简单,具有保护骨折周围软组织及血供,缩短手术时间,减少并发症等优点,术后可获得良好踝关节功能。Objective To explore the roles of poking reduction in the treatment of type II, III Pilon fractures. Methods According to Ruedi-Allgower classification, 54 cases of type II , III Pilon fractures were treated by the subject method randomly. In Group A （29 cases）, fractures were treated with percutaneous reduction of leverage by self-made leverage device, then stabilized by internal fixators. In Group B （25 cases）, fractures were stabilized by internal fixation. Ankle functional exercise was performed without weight bearing after operation. Ankle function were dertermined by Mazur criteria. Results The operation time of Group A was 1.5 ± 3.0 （2.4 ± 0. 3） h, Group B 2. 0 - 3.5 （2. 8 ± 0. 4） h, P 〈 0. 05. From postoperation follow-up ranging from 18 to 36 months （ average 24. 3 ± 6.4 months）, the fracture healing time of Group A and B were 12 - 16 （ 13.4 ± 3.4） weeks and 12 ± 18 （ 15.2 ± 3.5 ） weeks respectively. The case number in Group A showed excellent, good, fair and poor ankle function were 15,9,3 and 2, respectively. The case number in Group B showed excellent,good,fair and poor ankle function were 13,6,4 and 2, respectively. Twenty-four patients of Group A and nineteen patients of Group B showed good results in their ankle function. There were significant difference between the two groups in fracture healing time and ankle function recovery （P 〈 0. 05 ）. Conclusions The percutaneous reduction of leverage treatment for Type II , III Pilon fractures provides good recovery of ankle function.

关 键 词：PILON骨折 经皮撬拨复位 骨折固定术 内 植骨 

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