胫骨Pilon骨折的手术治疗

目的 探讨胫骨Pilon骨折的治疗方法、手术时机、手术方法。方法 随访1997年～2002年治疗的胫骨Pilon骨折16例,平均随访28.2个月。骨折类型:Ⅰ型3例,Ⅱ型5例,Ⅲ型8例。手术方法:合并腓骨骨折12例,占80％,均用钢板固定。胫骨骨折:螺钉固定5例,三叶草钢板固定5例,胫骨远端钢板固定2例,一期行踝关节融合3例。结果 按Mazur踝关节症状与功能评分系统评分:优5例,良5例,可3例,差3例。总体优良率为64％,并发症为31％。结论 对大部分Pilon骨折主张施行有限手术、有限内固定。而对严重胫骨关节面粉碎骨折的Ⅲ型骨折宜一期融合。

Operative Treatment of Pilon Fractures of the Distal Tibia

Objective To evaluate the choice of treatment, timing of operation and methods of surgery of tibia Pilon fractures. Methods Sixteen patients with tibia Pilon fractures operatively treated between 1997 and 2002 were followed up, the average period follow up was 28. 2 months. According to the Ruedi - Allgower classification, there were 3 cases of type I fracture, 5 cases of type II, 8 cases of type III fracture. The 12 cases of fibula fractures, which accounting for 80% of the totle cases, were reducted and internal fixed with plate. When treating tibia Pilon fractures, 5 cases were fixed with screws, 5 cases with cloverleaf plate, 2 cases with distal tibia plate and 3 cases were performed ankle fusion. Results According to Mazufs criterion, the results of treatment were evaluated as excellent in 5 cases, good in 5 cases, fair in 3 cases and poor in 3 cases. The totle percent of excellent and good outcome was 64% , and the totle percent of complications were 31% . Conclusion When treating tibia Pilon fractures, our opinion is limited operation and limited internal fixation. We performed ankle fusion when the distal tibia joint were severly comminuted in type III fracture.