微创分期治疗高能量pilon骨折的手术策略

目的探讨外固定支架结合微创、创面封闭负压吸引技术分期治疗高能量pilon骨折的手术时机、治疗方法选择及疗效评价。方法对60例高能量pilon骨折患者采用分期治疗,根据软组织条件在不同时间段采取不同治疗方法。一期采用临时固定法;二期采用创伤修复法;三期采用最终固定法。治疗中运用外固定支架技术、微创技术和创面封闭负压吸引技术。结果随访1年,按Burwell Charnley骨折复位放射学评价标准:解剖复位40例、复位可14例、差6例,优良率为90.00%。按Tornetta临床治疗结果评价标准评价术后功能:优36例、良12例、可8例、差4例,优良率为80.00%,无骨不连、创伤性骨髓炎发生。结论根据软组织损伤情况,选择合适的手术时机和手术方法是高能量pilon骨折治疗成功的关键。

Minimally invasive surgical treatment with stage management for high-energy pilon fracture

Objective To evaluate the significance of external fixator combined with minimally invasive,VAC muhi- staged management treating high energy pilon fractures. Methods According to the soft tissues conditions, 60 cases with high energy pilon fractures were managed in three stages：temporary fixing method in the first stage, wound repair method in the second stage, final fixation method in the third stage. External fixator,minimally invasive surgery and VAC were used in the treatment. Results All the cases were followed by 1 year. According to Burwell Charnley＇s criteria,the treatment outcome was evaluated as excellent in 40 cases,fair in 14,poor in 6. According to Tornetta＇s criteria,the treatment outcome was evaluated as excellent in 36 cases,good in 12,fair in 8,poor in 4. There were no bone nonunion case and traumatic osteomyelitis case. Conclusions It is important to have the right time of surgery and method of fixation in the treatment of high energy pilon fractures.