分期手术治疗开放性Pilon骨折的疗效观察  

Clinical observation of staged surgical treatment for open Pilon fractures

作　　者：朱燕辉[1] 王祥[1] 胡小鹏[1] 赵杰[1] 金晨[1] ZHU Yan-hui;WANG Xiang;HU Xiao-peng;ZHAO Jie;JIN Chen(Department of Orthopaedic Surgery,Shanghai Ninth People＇s Hospital,Shanghai Jiootong University School of Medicine,Shanghai Key Laboratory of Orthopaedic Implants,Shanghai 201999,China)

机构地区：[1]上海交通大学医学院附属第九人民医院骨科,上海市骨科内植物重点实验室,上海201999

出　　处：《中国骨与关节损伤杂志》2018年第10期1043-1045,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的观察分期手术治疗开放性Pilon骨折的临床疗效。方法回顾性分析自2013-01—2016-06诊治的27例开放性Pilon骨折,一期清创后采用外固定架固定或行跟骨牵引术,二期行切开复位钢板螺钉内固定。末次随访时采用Olerud-Molander评分标准评定踝关节功能。结果 27例均获得随访,随访时间平均18(11～37)个月。3例伤口发生皮缘坏死,换药后伤口延迟愈合;1例GustiloⅢB型伤口边缘出现部分皮肤坏死,切除坏死皮肤,创面新鲜后游离植皮;4例出现创面浅表感染,全身应用抗生素治疗及局部换药后感染得到有效控制,创面愈合。骨折均在术后4～7个月骨性愈合。末次随访时Olerud-Molander评分平均92(75～100)分。2例踝关节功能评分为75分,1例术后12个月X线片显示踝关节有骨关节炎表现,1例术后X线片显示踝关节骨性融合。结论对于开放性Pilon骨折,一期彻底清创外固定架固定或行跟骨牵引术可降低感染风险,为软组织修复提供相对稳定的力学环境;二期内固定在软组织条件相对安全下进行,踝关节面骨折解剖复位,骨折坚强内固定有利于踝关节早期功能锻炼。Objective To observe the clinical effect of staged surgical treatment for open Pilon fractures. Methods Twenty- seven cases of open Pilon fractures were analyzed retrospectively from January 2013 to June 2016. External fixator or calcaneal traction was used after primary debridement, second-stage open reduction, plate and screw internal fixation were performed. At the last follow-up, Olerud-Molander score was used to evaluate the ankle function. Results All 27 patients were followed up for an average of 18 （11-37） months. Skin necrosis occurred in 3 cases and healed after dressing change. Partial skin necrosis occurred in 1 case of Gustilo type 111 B wound, necrotic skin was excised and free skin grafting was performed after fresh wound. Superficial wound infection occurred in 4 cases, infection was effectively controlled after systemic antibiotic treatment and local dressing change, and wound healing was achieved. All fractures healed at 4-7 months postoperatively. The mean Olerud-Molander score was 92 （75-100） at the last follow-up. The ankle function score was 75 in 2 cases, 1 case showed osteoarthritis on X-ray film 12 months after operation, and 1 case showed ankle bone fusion on X-ray film after operation. Conclusion For open Pilon fractures, one-stage debridement with external fixator or calcaneal traction can reduce the risk of infection and provide a relatively stable mechanical environment for soft tissue repair; second-stage internal fixation is performed under relatively safer soft tissue conditions. Anatomical reduction of the ankle and strong internal fixation are conducive to early functional exercise of the ankle.

关 键 词：开放性PILON骨折 分期手术 外固定架 钢板螺钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]