【摘要】 目的探讨胫骨远端Pilon骨折的手术时机及术式设计。方法回顾性分析我院2007年1月至2015年1月期间胫骨远端Pilon骨折手术治疗患者45例,根据Ruedi-Allgower分型分为Ⅱ型23例和Ⅲ型22例,比较不同Ruedi-Allgower分型的骨折的手术时机及术式(切开复位内固定术、分步延期切开复位内固定术和外固定结合有限内固定术)的疗效。结果不同Ruedi-Allgower分型的手术方式比较差异无统计学意义(P>0.05),Ruedi-AllgowerⅡ型以7~10 d手术为主,Ruedi-AllgowerⅢ型以6~8 h手术为主,同种手术时机的Ruedi-AllgowerⅡ分型比较差异具有统计学意义(P<0.05),不同手术方式的治疗优良率与并发症发生率比较差异无统计学意义(P>0.05),分步延期切开复位内固定与外固定结合有限内固定手术时间明显短于早期切开复位内固定术(P<0.01),分步延期切开复位内固定患者骨性愈合时间明显短于外固定结合有限内固定患者(P<0.01),且分步延期切开复位内固定患者骨性愈合时间明显短于早期切开复位内固定(P<0.05)。结论准确把握胫骨远端Pilon骨折手术时机,综合评估骨折程度优先选择分步延期切开复位内固定术,有助于显著缩短手术时间与骨性愈合时间。更多还原

【Abstract】 Objective To investigate the surgical timing and surgical design of distal tibial Pillon fracture. Methods A total of 45 cases with distal tibial Pilon fractures in our hospital from 2007 January to 2015 January were retrospectively analyzed. According to Ruedi-Allgower classification,patients were divided into Ruedi-Allgower type II group(n =23) and Ruedi-Allgower type III group(n=22). Surgical procedure involved three approaches, open reduction and internal fixation, two-stage delayed open reduction internal fixation and external fixation combined with limited internal fixation effect. The time and mode of operation were analyzed in two groups. Results There was no significant difference in different operation mode. The operation of Ruedi-Allgower type II was mainly performed in 7-10 day after trauma, and Ruedi-Allgower type III in 6-8 h. In patients with Ruedi-Allgower II,III, open reduction internal fixation(ORIF) surgery treatment had better clinical effect than the early open reduction and internal fixation, but bone healing time was significantly less than that of open reduction and internal fixation in early stage(P <0.05). The comparison of treating excellent rate and complication incidence among different surgical way had no significant difference(P >0.05), operation time of two-stage delayed open reduction internal fixation and external fixation combined with limited internal fixation were significantly shorter than open reduction and internal fixation(P<0.01), osseous healing time of two-stage delayed open reduction internal fixation was significantly shorter than external fixation combined with limited internal fixation(P<0.01), and osseous healing time of two-stage delayed open reduction internal fixation was significantly shorter than open reduction and internal fixation(P <0.05). Conclusion Accurately grasps the distal tibial Pilon fracture operation time, it preferred twostage delayed open reduction internal fixation by comprehensively evaluating fracture degree, it helps significantly shortening operation time and osseous healing time.更多还原