【作者】 赵滨； 张云强； 陈艺新； 贾湘谦； 王积辉；

【Author】 Zhao Bin,Zhang Yunqiang,Chen Yixin,et al.Department of Orthopaedics,Guiyang Fourth People’s Hospital(Guizhou Guiyang,550002,China.)

【机构】 贵阳市第四人民医院骨科；

【摘要】 目的:探讨pilon骨折几种手术方法的适应证及效果。方法:1994年1月至2005年1月共手术治疗pilon骨折54例。男36倒,女18例。年龄17-69岁,平均36岁。开放性15例,闭合性39例。Ruedi-AllgowerⅠ型9例、Ⅱ型15例、Ⅲ型30例,AO分型,B3|C1型8例,C2型17例,C3型29例。采用闭合复位或有限切开复位+外固定架治疗37例;切开复位、钢板螺钉内固定17例。结果:16例失去随访,38例获1年以内随访,17例获得1年以上随访,平均随访时间36月(6-60个月);骨折全部愈合,平均愈合时间21周,5例出现内翻畸形愈合,3例伤口皮缘浅表坏死,经局部换药后痊愈。5例出现骨性关节炎表现,其中1例行踝关节置换术。Mazur评分,优12例,良13例,可7例,差6例。结论:Pilon骨折的治疗应根据骨折类型、软组织损伤程度选择手术方法,才能提高疗效,减少并发症。更多还原

【Abstract】 Objective:To investigate the indications and the effect of operative treatment of pilon fractures.Methods:Fifty - four cases of pilon fractures were treated with surgical methods from January 1994 to January 2005.There were 36 males and 18 females, the average age was 36 years(ranged,17 - 69 years),15 cases were opened fractures and 39 cases were closed.According to Ruedi - Allgower classification,there were 9 cases of typeⅠfracture,15 cases of typeⅡand 30 cases of typeⅢ.(8 cases of type B3/C1,17cases of type C2 and 29 cases of type C3 in AO classification).37cases were treated with closed reduction or limited open reduction and external fixation,17cases with open reduction and internal fixation.Results:Sixteen cases could not be followed up,the remaining thirty - eight cases were followed up for an average of 36 months(ranged,6-60 months) in which 17 cases were followed over one year.All fractures united,but malunion was observed in 5 patients,the time to fracture union averaged 21week(ranged,11-36weeks).The complications included that superficial wound edge necrosis was only noted in three cases which healed by local wound care without a further soft tissure coverage procedure and 5 cases suffered from severe traumatic arthritis in which 1 case was treated with replacement of ankle joint.After evaluated according to the criteria of Mazur’s score,there were 12 cases assessed as being excellent,13 as good 7 cases as fair and 7cases as poor.Conchtions:The treatment protocol of pilon fractures should be determined based on the type of fracture and severity of soft - tissue injury to improve the effect and reduce the complications.更多还原