Rüedi-AllgowerⅢ型Pilon骨折的手术治疗  

SURGICAL TREATMENT OF Rüedi-Allgower Ⅲ Type Pilon FRACTURES

作　　者：吴一芃[1] 徐永清[1] 师继红[1] 朱跃良[1] 

机构地区：[1]成都军区昆明总医院附属骨科医院,昆明650032

出　　处：《中国修复重建外科杂志》2014年第7期828-831,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨Rüedi-AllgowerⅢ型Pilon骨折的手术方法及效果。方法 2011年5月-2013年4月收治25例Rüedi-AllgowerⅢ型Pilon骨折患者。其中男16例,女9例;年龄24-45岁,平均31岁。左侧8例,右侧17例。开放性骨折5例,闭合性骨折20例。致伤原因：高处坠落伤11例,交通事故伤9例,砸伤5例。受伤至入院时间10-36 h,平均23.5 h。采用经腓骨后外侧切开复位腓骨＋经胫前外侧入路切口暴露胫骨远端及胫距关节面,直视下复位胫距关节面并固定胫骨骨折端进行治疗。结果术后15例切口Ⅰ期愈合;6例行植皮术患者术后切口Ⅱ期愈合;4例术后出现张力性水疱,经相应治疗后切口Ⅱ期愈合。25例均获随访,随访时间6-12个月,平均8个月。X线片示踝关节面稳定,胫距关节面解剖复位或接近解剖复位,胫骨远端骨折端力线正常,骨折处骨性愈合良好。随访期间无踝关节不稳、创伤性关节炎及内固定物松动、脱落、断裂等并发症发生。术后6个月-1年手术取出内固定物后,患者踝关节屈伸活动正常,无行走时踝关节疼痛感。末次随访时参照Mazur等的踝关节症状与功能评分系统进行评估,获优5例,良12例,可5例,差3例;优良率68%。结论经腓骨后外侧及胫前外侧双侧入路能完整显露胫距关节面,直视下复位胫距关节面并固定胫骨骨折端治疗Rüedi-AllgowerⅢ型Pilon骨折,可获较好疗效。Objective To study the surgical treatment method and effectiveness of Rüedi-Allgower III type Pilon fractures. Methods Between May 2011 and April 2013, 25 cases of Rüedi-Allgower III type Pilon fracture（5 cases of open fractures and 20 cases of closed fractures） were treated. Of 25 cases, 16 were male, and 9 were female, aged 24-45 years（mean, 31 years）. The left side was involved in 8 cases, and the right side in 17 cases. The disease causes were falling from height in 11 cases, trai c accident injury in 9 cases, and crash injury in 5 cases. The interval of injury and admission was 10-36 hours（mean, 23.5 hours）. The open reduction and internal i xation by posterolateral i bular incision and exposure of distal tibia and tibiotalar articular surface by anterior ankle incision were performed; the tibiotalar articular surface was reset and the tibia fracture end was i xed. Results Healing of incision by i rst intention was obtained in 15 cases, and healing by second intention in 6 cases undergoing skin grafting. Tension blister occurred in 4 patients, who achieved healing by second intention after treatment. All 25 patients were followed up 6-12 months（mean, 8 months）. During follow-up, no complication of ankle joint instability, traumatic arthritis, or loosening and breakage of internal i xation occurred. The X-ray i lms showed stable ankle joint, anatomic or near anatomic reduction of the tibiotalar articular surface, normal alignment of distal tibia, and good bony healing. At 6 to 12 months after operation, the l exion and extension of the ankle were normal, without pain of the ankle joint after removal of internal i xation. According to Mazur et al. rating system for ankle symptoms and function, the results were excellent in 5 cases, good in 12 cases, fair in 5 cases, and poor in 3 cases; the excellent and good rate was 68%. Conclusion The procedure by anterior ankle lateral approach and posterolateral i bular approach can completely expose the tibiotalar articular surface, which is advantageou

关 键 词：Rüedi-AllgowerⅢ型Pilon骨折 胫距关节面 下胫腓联合 

分 类 号：R687.3[医药卫生—骨科学]