合并软组织缺损Pilon骨折的治疗

目的观察外固定架结合皮瓣转位一期治疗合并软组织缺损Pilon骨折的疗效。方法15例合并软组织缺损Pilon骨折患者，急诊清创后使用有限内固定结合外固定架固定骨折，同时以胫后动脉穿支皮瓣、远端蒂腓肠神经营养皮瓣、外踝上皮瓣或者交腿皮瓣一期修复软组织缺损，对干骺端骨缺损处3个月后取自体髂骨植骨。结果15例获得6-24个月随访，平均16．5个月。皮瓣均存活，骨折全部愈合，骨折愈合时间3～12个月，平均8．5个月。参照Mazur踝关节功能评分标准评定：优10例，良3例，可1例，差1例；优良率86．7％。结论外固定架结合皮瓣转位可一期治疗合并软组织缺损Pilon骨折。

Clinical Study on the Treatment of Pilon Fracture with Soft Tissure Defect by External Fixtion Combined with Flap Transposition

Objective To observe the therapeutic effect of pilon fracture by external fixtion combined with flap transposition. Methords 15 pilon fracture patients combined with soft tissure defect were observed. The fractures were treateded with external fixtion and limited internal fixtion after emergency debridement. The soft tissure defects were repaired with flap nutriented by perforate branches of posterior tibialartery, reversed sural neurocutaneous island flap, the lateral supramalleolar flap or cross leg flap. The bone defects of metaphysis were repaired with iliac bone graft 3 months later. Results Both cases were followed up for 6 to 24 months(average 16.5months). All flaps were survived and the fractures were healed, the healing time from 3 to 12 months(average 8.5months). According to Mazur evaluation criteria, the result can be:10 excellent, 3 good, 1 fair and and 1 poor. The excellent-and-good rate was 86.7%. Conclusion External fixtion with flap transposition can primarily treat pilon fracture combined with soft tissure defect.