高能量Pilon骨折三种治疗方法的比较

目的 总结3种方式治疗高能量Pilon骨折的临床效果,探讨最佳治疗方案。方法 自1995年1月~2003年1月共收治高能量损伤所致Pilon骨折79例,其中67例获得随访。按治疗方式可分为3组:解剖型钢板内固定24例为A组;有限内固定结合超关节外固定架治疗18例为B组;短期骨牵引或外固定架固定后改用钢板内固定两阶段治疗方案治疗25例为C组。结果 67例获11个月~8年随访,结果显示3种治疗方法在治疗效果和并发症发生率上有差别,以C组治疗结果最佳。按:Mazur等制定的评分系统,其临床疗效优良率为80.0％,其并发症发生率为32.0％。结论 短期骨牵引或外固定架固定后二期用钢板内固定能较好地恢复踝关节功能,减少并发症的发生率,值得推广。

Comparison of Three Kind of Methods in Treatment of Severe Pilon Fracture

Objective To evaluate the clinic outcome of severe Pilon fractures treated with three kind of methods respectively and to investigate the optimal treatment method. Methods From January 1995 to January 2003, 79 cases of severe Pilon fracture were treated in our department, among which 67 cases were followed up. They were divided into three groups according to treatment methods. Group A included 24 cases were treated with internal fixation with plating of tibia and fibula following the AO principles; Group B included 18 cases were performed limited internal fixation combined with external fixators; Group C included 25 cases were undergone in two- stage: Internal fixation with anatomical plate applied in a second step after initial reconstruction of the joint with short - term traction of calca-neus or fixation with external fixator. Results After 11 months to 8 years follow - up, it was found that three kinds of treatment methods had significant differences on the outcomes and complications. The group C got the best results. Conclusion The two- staged therapy and internal fixation with anatomical plate may provide satisfactory fracture reduction and clinical results for severe Pilon fracture. This kind of treatment is worth to recommend for the severe Pilon fracture.