高能量Pilon骨折的分期治疗策略

目的：探讨分步延期内固定方法治疗高能量Pilon骨折的临床疗效。方法：2006—03—2012—03收治高能量Pilon骨折31例，其中开放性骨折26例，闭合性骨折5例；Reudi—Allgower分型，Ⅱ型13例，Ⅲ型18例。人院后根据软组织损伤情况及开放和闭合性骨折分类，均行急诊手术，闭合伤口，开放性骨折组先行清创术，一期行腓骨骨折切开复位钢板固定，胫骨骨折应用超关节外固定架临时固定或跟骨牵引；待肿胀消退、软组织条件恢复后，二期拆除外固定行胫骨远端骨折内固定治疗。结果：31例骨折全部愈合，愈合时间12～24周，平均13周。术后所有患者均获随访，随访7～58个月，平均随访35个月。按Burwell Chamley Pilon骨折复位放射学评价标准：解剖复位22例、复位可6例、差3例，优良率为90．32％。按Tornetta骨折临床疗效评价术后功能：优18例、良7例、可4例、差2例，优良率为80．65％。术后无骨不连、骨髓炎、深部软组织感染病例，发生创伤性关节炎2例，骨折延迟愈合1例。结论：高能量Pilon骨折的分步延期治疗策略兼顾了软组织损伤及骨折碎裂重的特点，充分发挥了外固定及内固定两者各自的优势，较大地减少了手术并发症，取得了较好的临床效果，是一个较安全有效的治疗方案。

Staging strategy for the treatment of high energy Pilon fractures

Objective：To ao analyze the results of distal tibial pilon fractures treated with step-by-step extension internal fixation. Method： 2006-03--2012-03,31 high energy pilon fractures were primarily treated with ener- gent surgery according the conditions of soft tissue and open or close fracture. Of 26 cases,21 were open fractures and 5 close fractures,According to Ruedi-Mlgower classfication,the fractures were classified as type lI in 13 and type IlI in 18. Open fractures were firstly given with debridement,and received first stage fibular open reduction. Tibia fracture were firstly given over-articular external fixation or calcaneal traction fracture. The definitive internal fixations were performed to fix the distal tibial fractures as soon as the soft tissue recovered. Result：The heal-time ranged from 12 to 24 mollths,with the mean of 13 months. All the patients were followed up from 7 to 58 months, with the mean of 35 months. The outcome of reduction was evaluated by the Burwell Chamley score. Anatomical reduction was found in 22 cases,function reduction was in 6 cases and poor reduction was 1 case. The postoperative function by the Tornetta fracture scoring, results were excellent in 18 cases, good in 7 cases, favorable in 4 cases and poor in 2 cases. The rate of excellent operation was 80.65 ~. The complications were as follows：2 cases with traumatic arthritis and l case with delayed union. Conclusion：The step-by-step delayed strategies for the treatment of high energy Piton fractures take account of the serious fracture and heavy soft tissue,fully utilize the respective advantages of external fixation and internal fixation, Significantly reduce the operation complications, and have obtained the good clinical effect, with is a safe and effective therapy for pilon fractures.