胫骨Pilon骨折的治疗

目的：探讨各种固定方法对Pilon骨折的治疗效果。方法：回顾分析我院1996年7月～2002年6月所有收治Pilon骨折资料完整的病例66例。牵引或石膏托固定17例。单纯支架外固定8例，有限内固定结合外固定支架19例，支持钢板内固定22例。结果：随访0．5～6年，按Helfet标准进行功能评价。Ⅰ型14例优良率92．9％，Ⅱ型29例优良率82．8％，Ⅲ型23例优良率47．8％。结论：治疗效果决定于原始损伤程度、复位的质量和选择固定方法是否适当。     

切开复位内固定治疗胫骨Pilon骨折

目的：评价切开复位内固定术对Pilon骨折的治疗效果。方法：自1993年3月－1998年10月，应用切开复位内固定治疗Pilon骨折35例，其中18例行胫骨关节面的有限固定，17例行前或内铡支撑钢板固定，随访0．5－5年，按Helfet标准进行功能评价。结果：23例Ⅱ型损伤中，优良率为85％；Ⅲ型损伤的12例中，优良率为50％。结论：治疗的效果决定于原始损伤的程度、复位的质量和固定的稳定性。切开复位内固定是一种疗效满意的治疗方法之一。     

手术治疗胫骨Pilon骨折

目的探讨胫骨Pilon骨折后石膏托外固定或局麻下行跟骨骨钉牵引治疗后，行切开复位内固定术治疗的临床疗效。方法1996年8月-2005年1月，收治Pilon骨折患者22例。男16例，女6例。年龄17～55岁，平均35．5岁。采用Ruedi—Allgower分型：I型3例，Ⅱ型15例，Ⅲ型4例。伤后予以石膏托外固定或在局麻下行跟骨骨钉牵引治疗7～14d后，采用切开复位内固定术治疗。结果术后切口均I期愈合。患者均获随访1年5个月～3年，平均2．4年。X线片示术后10-32周骨折愈合，平均15周。根据Mazur踝关节症状和功能评分系统评定：优12例，良5例，可3例，差2例，优良率为77．2％。术后并发慢性骨髓炎1例，踝内翻1例，创伤性关节炎改变15例。结论术前评估软组织损伤情况，选择合适治疗时机，根据胫骨Pilon骨折类型选择适当的内固定方式可获得良好复位，减少并发症的发生。     

有限内固定结合外固定支架治疗Pilon 骨折

目的总结有限内固定结合外固定支架治疗Pilon骨折的疗效及并发症。方法回顾性分析1996年4月～2003年6月，应用有限内固定结合外固定支架治疗的20例Pilon骨折（治疗组）和手法复位跟骨牵引、手法复位石膏固定、切开复位有限内固定治疗的22例Pilon骨折（对照组），比较各组骨折治疗前后X线片、临床疗效和并发症。结果获随访8～26个月，平均15．2个月。临床疗效参照Helfet评定标准：治疗组优良率为75％，对照组为72．7％，二者差异无统计学意义（P〉0．05）。X线片评价按Burwell—charnley标准，治疗组疗效优良率为90％，对照组为86．4％，二者差异无统计学意义（P〉0．05）。治疗组与对照组并发症发生情况差异有统计学意义（P〈0．05）。结论有限内固定结合外固定支架能较好恢复踝关节功能，减少并发症，尤其是对减少软组织并发症和防止关节面再塌陷有明显优点，可作为治疗Pilon骨折的较好方法。     

切开复位内固定治疗胫骨Pilon骨折

Pilon骨折是关节内骨折中较难治疗的一种创伤，常伴有外踝骨折和下胫腓联合分离，其特征是踝关节上干骺端具有典型的、不同程度的压缩粉碎性表现。其高度的不稳定，关节软骨的原发性损伤以及永久性关节面不平整，常导致不良的预后。治疗上有一定的困难。自1994～2001年共收治该病例26例，现将治疗情况总结如下。     

胫骨Pilon骨折的治疗现状与进展

胫骨Pilon骨折是指胫骨远端1/3波及胫距关节面的骨折,常合并有腓骨下段骨折和严重的软组织挫伤.按Ruedi-Allgower的分类法[1]分3型;Ⅰ型:较少移位;Ⅱ型:明显的关节面移位而粉碎程度较小;Ⅲ型:关节面粉碎移位及粉碎程度均较严重.胫骨pilon骨折约占下肢骨折的1%～10%[2],在胫骨和踝关节骨折中占4%～7%[3,4],随着交通运输和工农业生产的发展,由高能量暴力造成的该部位骨折有增多的趋势,而且伤情更加复杂、并发症多、致残率高,是最难治疗的骨折之一[4,5],由于胫骨远端血供差、软组织薄,不能提供良好的血运及保护,而且关节面嵌压,严重粉碎,以致于pilon骨折治疗极其困难.近年来,国内外学者对此类骨折的治疗方法、固定器械和固定材料的改进等方面取得了明显的成效,现将有关治疗进展综述如下.     

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。     

25例胫骨Pilon骨折的手术治疗

目的探讨胫骨Pilon骨折的外科治疗方法及临床疗效。方法回顾分析本院近4年收治有完整随访记录的Pilon骨折28例。根据损伤程度及临床分型：Ⅰ型3例、Ⅱ型12例、Ⅲ型13例，其中Ⅰ型给予保守治疗3例，其余予手术治疗。结果术后随访8～48个月，平均21个月。采用Mazur评分标准，优13例，良8例，可3例，差1例。结论根据骨折分型及软组织条件选择适宜手术时机及合理治疗方式，可取得满意疗效。     

有限内固定结合外固定支架治疗Pilon骨折

目的：回顾性分析了有限内固定结合外固定支架治疗Pilon骨折的手术疗效。方法：23例患接受该方法治疗，其中，男16例，女7例。骨折类型：Ⅰ型2例，Ⅱ型3例，Ⅲ型9例，Ⅳ型5例，Ⅴ型4例。Ⅰ、Ⅱ型在“C”臂机监视下闭合复位，“T”型单侧多功能外固定支架或组合式外固定支架固定。Ⅲ、Ⅳ、Ⅴ型采用踝前小切口，以螺钉有限内固定结合组合式外固定支架外固定。术后平均随访21个月，结果：采用Mazur评分系统评估手术疗效，优：16例，良：5例，可：1例，差：1例。术后并发症包括：针道感染3例，螺钉松动2例。结论：有限内固定结合外固定支架是治疗高能量Pilon骨折（尤其Ⅲ、Ⅳ、Ⅴ型）的较好方法。     

锁定钢板治疗胫骨远端Pilon骨折

目的探讨胫骨远端锁定解剖钢板在胫骨远端Pilon骨折的临床应用疗效。方法对于25例胫骨远端Pilon骨折采用胫骨远端锁定解剖型钢板内固定。结果 24例随访12～18月,踝关节关节外观正常,采用Mazur等制定的踝关节症状与功能评分系统,其中优16例,良5例,可2例,差1例,优良率达87.5%。结论胫骨远端锁定解剖钢板具有高度的稳定性,是治疗胫骨远端Pilon骨折,尤其是粉碎性及骨质疏松性骨折的理想方法。     

Taylor spatial frame in the treatment of open tibial shaft fractures

Background:

The Taylor spatial frame (TSF) is a modern multiplanar external fixator that combines the ease of application and computer accuracy in the reduction of fractures. A retrospective review of our prospective TSF database for the use of this device for treating open tibial fractures in pediatric, adolescent, and adult patients was carried out to determine the effectiveness and complications of TSF in the treatment of these fractures.

Materials and Methods:

Nineteen male patients with open tibial fractures were included. Of these fractures, 10 were Gustilo Type II, five were Gustilo Type IIIA (two had delayed primary closure and three had split thickness skin grafting), and four were Gustilo Type IIIB (all had rotational flaps). Twelve of our patients presented immediately to the emergency room, and the remaining seven cases presented at a mean of 3 months (range, 2.2-4.5 months) after the initial injury. The fractures were located in proximal third (n=1), proximal/middle junction (n=2), middle third (n=3), middle/distal junction (n=8), distal third (n=3), and segmental fractures (n=2). Patients were of an average age of 26 years (range, 6-45years). Mean duration of follow-up was 3.5 years.

Results:

All fractures healed over a mean of 25 weeks (range, 9-46 weeks). All were able to participate in the activities of daily living without any difficulty and most were involved in sports during the last follow-up. Postoperative complications included pin tract infection in 12 patients.

Conclusion:

The TSF is an effective definitive method of open tibial fracture care with the advantage of early mobilization, ease of soft tissue management through gradual fracture reduction, and the ability to postoperatively manipulate the fracture into excellent alignment.     

Treatment of complex tibial plateau and distal tibial fractures with Taylor spatial frame: experience in a district general hospital

Complex tibial fractures especially intraarticular pilon and plateau fractures are difficult to manage. Literature shows poor results in the treatment of these fractures due to complexity of the fracture and involvement of articular surface. Taylor spatial frame (TSF) is a hybrid, multiplanar, external fixator, which uses the slow correction principles of Ilizarov system. Specialised centres around the world use these frames to treat various long bone fractures and to correct deformities. Very few district general hospitals and hospitals of similar set-up deal with these injuries. TSF was used to treat 26 complex intraarticular fracture of tibial plateau (Schatzkar type IV–VI) and pilon fractures (Rudi III) in a district general hospital. Seventeen were pilon and nine were plateau fractures. There were 21 male and 5 female patients. Average length of time patients had the frames on was 191 days. The average follow up was 14 months. The average operative time was 2 h 13 min for pilon fractures, 2 h 37 min for tibial plateau fractures. Fourteen patients did not have any complications. Twelve had 1–3 pin-site infection. Four had chronic pain. Two pilon fractures had delayed union and one had nonunion. One patient had foot compartment syndrome and underwent decompression. No cases of osteomyelitis, broken pins or nerve palsy occurred. With proper training, preoperative and postoperative care, TSF can be used in a district general hospital safely. The procedures can be planned well in advance. Referral to specialist centre, possible complications during transfer and a second procedure at the referral centre could be avoided.     

青少年Pilon骨折的治疗

目的探讨青少年Pilon骨折的特点、治疗方法及其并发症。方法对1990年4月～2003年12月期间治疗的13例青少年胫骨Pilon骨折病例进行随访分析。按Merv—Letts分型：Ⅰ型5例，Ⅱ型6例，Ⅲ型2例。骨牵引治疗2例，有限内同定8例，有限内固定结合外固定支架3例。结果所有患者平均随访24个月，按Helfet踝关节功能评价：优8例，良4例，差1例，优良率92．3％。并发症：皮肤坏死2例，创伤性关节炎4例，骨骺早闭3例，畸形愈合1例，骨延迟愈合1例，外固定支架钉道感染1例，总体并发症38．5％。结论青少年Pilon骨折应根据其分型采用不同的治疗方案：疗效与创伤程度有关：Ⅲ犁骨折有较高的并发痹。     

胫骨远端解剖接骨板治疗Pilon骨折

2002年2月-2005年12月,我科对16例Pilon骨折患者均采用解剖接骨板内固定治疗,现将治疗效果分析如下。     

泰勒支架矫正踝关节周围畸形

[目的]探讨泰勒支架在踝关节周围畸形矫正中的应用疗效。[方法]2014年7月～2017年7月共治疗踝关节周围畸形10例,术前常规拍标准踝关节正位X线片,根据影像学资料全面评估踝关节短缩、成角、旋转、移位情况,设计截骨平面。术中根据截骨平面按照穿针要求两侧安装固定泰勒环,近端标准环垂直骨平面,依据所定位截骨平面进行截骨操作,确认截断后,连接固定连接杆并将6根连接杆序码按照要求安装。术后1周复查,拍摄标准的正侧位X线片以及大体照片,于X线片上测量踝关节的畸形参数,并用电脑输入畸形参数来模拟矫正结果并获得畸形的矫正参数。然后依据新生成的矫正处方调整6个连接杆,调整结束后,再次拍摄标准正侧位X线片、外观照片。根据处方提示,必要时更换需要调整的连接杆直至畸形矫正,截骨处愈合,功能良好,逐步拆除外固定架。[结果]所有患者均获得随访,随访时间3～12个月,所有患者踝关节功能恢复良好,畸形得到纠正。[结论]泰勒支架在矫正畸形的同时可进一步调整踝关节的活动度,使之接近正常生理解剖,术后恢复功能、外观良好,为治疗踝关节周围畸形提供了一种新的方法。     

计算机辅助Taylor空间支架治疗开放性胫腓骨骨折

[目的]探讨运用计算机辅助Taylor空间支架治疗胫腓骨开放性骨折的临床疗效。[方法]回顾性分析2015年8月～2017年3月收治的41例单侧小腿开放骨折患者临床资料。根据治疗方式,21例采用计算机辅助Taylor外固定架治疗,20例采用单边外固定架治疗。比较两组手术时间,术后并发症发生率,外架拆除及骨折愈合时间,以及Johner-Wruhs评价标准评定的患肢功能。[结果] Taylor架组手术时间和早期术后并发症显著少于单边架组,差异均有统计学意义(P0.05),Taylor架组术后1例针道感染,2例下肢静脉血栓形成;单边架组术后存在2例针道异物反应及5例下肢静脉血栓形成。对症治疗后均好转。两组患者均获随访5～20个月,平均(13.19±3.03)月。Taylor架组带架时间与骨折愈合时间均显著少于单边架组,差异有统计学意义(P0.05)。按Johner-Wruhs评价标准,Taylor架组临床效果优良率为85.71%;单边架组为70.00%,两组差异无统计学意义(P0.05)。[结论]计算机辅助Taylor空间支架治疗胫腓骨开放骨折能有效缩短手术时间,降低手术并发症,避免二次损伤软组织,同时能有效缩短患者带架时间与骨折愈合时间。     

Taylor spatial frame in the treatment of neglected fractures

Background  

The Taylor spatial frame (TSF, Smith and Nephew, Memphis, TN, USA) is a modern multiplanar external fixator that combines ease of application and computer accuracy. Many patients in our geographic area seek treatment for their fractures by traditional bonesetters and present in the middle of treatment with neglected malaligned fractures. These fractures were an average of 10 weeks old (range 6–14 weeks) fractures with callus that were allowed to heal in a poor position. The spatial frame is applied easily on the fracture bone fragments. The accuracy of fracture reduction and deformity correction is dependant on analyzing anteroposterior and lateral radiographs of the fracture. Our experience with this external fixator in the treatment of neglected fractures is summarized.     

Correction of tibial deformity in Paget's disease using the Taylor spatial frame

A 64-year-old man presented with a severe deformity of the tibia caused by Paget's disease and osteoarthritis of the ipsilateral knee. Total knee replacement required preliminary correction of the tibial deformity. This was successfully achieved by tibial osteotomy followed by distraction osteogenesis using the Taylor spatial frame. The subsequent knee replacement was successful, with no recurrence of deformity.