超关节外固定支架结合有限内固定治疗高能量Pilon骨折  

Over articular external fixator combined with limited internal fixation for the treatment of high energy Pilon fractures

作　　者：刘大诚[1] 杨效宁[2] 黄长智[3] 孙一公[2] 戴醒明[2] 

机构地区：[1]徐州医学院研究生学院,江苏徐州221000 [2]徐州市第一人民医院骨科,江苏徐州221002 [3]福建医科大学附属宁德市医院骨科,福建宁德355000

出　　处：《中国骨伤》2014年第4期331-334,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的：讨论超关节外固定支架结合有限切开内固定治疗高能量Pilon骨折的临床疗效.方法：自2003年9月至2011年4月应用超关节外固定支架结合有限内固定治疗36例高能量损伤的Pilon骨折患者.男25例,女11例;年龄16～72岁,平均38岁.患者术前可以通过常规X线检查或行三维螺旋CT检查明确诊断.术后采用AOFAS评分标准对疗效进行评定.对于骨折断端是粉碎的、不平整的,可以用螺钉、克氏针或钢丝固定,无须剥离骨膜,可以使骨折断端和骨折块之间相互靠拢以增强稳定性,然后超关节外固定支架固定.结果：所有患者获随访,时间4～27个月,平均13个月.32例伤口Ⅰ期愈合.骨折愈合时间2～6个月,平均3个月.踝关节活动度和骨折愈合按AOFAS评分标准进行评定,总分88.2±3.6;优13例,良20例,可3例.12例发生针孔感染,5例出现针孔处疼痛,1例因过度负重导致固定针断裂,经处理均获得痊愈.无神经、血管损伤及骨髓炎等并发症.结论：超关节外固定支架结合有限切开内固定治疗高能量Pilon骨折固定确切、操作简单、符合生物力学固定原则,有利于骨折愈合.To study clinical effects of the over-articular external fixator combined with limited internal fixation for the treatment of Pilon fractures caused by high energy. Methods：From September 2003 to April 2011,36 patients with Pilon fractures caused by high energy were treated with the over-articular external fixator combined with limited internal fixator. There were 25 males and 11 females ,ranging in age from 16 to 72 years old ,with an average of 38 years old. The diagnoses of all patients were determined by conventional X-ray examination or three-dimensional spiral CT examination. The AOFAS scoring criteria was used to evaluate the therapeutic effects. The patients with comminuted fractures were treated with screw or Kirschner wire fixation without uncovering periost so as to enhance stability between fracture end and bone blocks ,followed by the fixation with over-articular external fixators. Results：All the patients were followed up, and the duration ranged from 4 to 27 months,with an average of 13 months. Thirty-two patients got wound healing at the first stage. And the bone union duration ranged from 2 to 6 months ,with a mean of 3 months. According to the AOFAS ankle-hindfoot subjective scoring standard, 13 patients got an excellent result, 20 good and 3 fair, with an score of 88.2-4-3.6. Twelve patients had infections at pinhole, 5 patients had pinhole pain. One patient had the fixator broken induced by over loading ,who was cured after treatment. There were no complications such as nerve or vascular injuries, or osteomyelitis. Conclusion：The over-articular external fixation combined with limited internal fixation for the treatment of Pilon fractures caused by high energy is an ideal method ,which has such ad- vantages as reliable fixation, simple operation, coincidence with principles of biomechanical fixation, and benefit for fracture healing.

关 键 词：PILON骨折 踝关节 外固定器 内固定器 

分 类 号：R683[医药卫生—骨科学]