动力型外固定支架结合有限内固定术治疗Pilon骨折

目的评价复位手法、动力型外固定支架结合有限内固定治疗复杂Pilon骨折的疗效。方法 2007年1月～2009年6月,采用手法复位、动力型外固定支架结合有限内固定治疗23例复杂Pilon骨折。根据Ruedi-Allgower分类标准,Ⅱ型14例,Ⅲ型9例。结果所有患者术程顺利,手术用时平均57min,术中出血量平均75ml,术中无神经、血管损伤。随访23例,随访时间6～24个月,平均17个月。未发生螺钉松动及切口深部感染。3例出现钉道浅部感染,均通过换药等局部处理后治愈;轻度踝内翻1例;创伤性关节炎1例。骨折均愈合,平均愈合时间4.2个月。按Mazur踝关节临床症状及功能评分系统进行评分,优15例,良5例,可2例,差1例,优良率87.0%。结论复位手法、动力型外固定支架结合有限内固定能够减少切开复位带来的软组织损伤,避免对骨折端血供的破坏,具有出血量少、创伤小、手术时间短、骨不连发生率低等优点,是治疗复杂Pilon骨折的较好选择。

Dynamic external fixator combined with limited internal fixation for Pilon fractures

Objective To evaluate effects of manipulative reduction, dynamic external fixator combined with limited internal fixation for the treatment of Pilon fractures. Methods From January 2007 to June 2009, manipulative reduction, dynamic external fixator combined with limited internal fixation were performed to treat 23 cases of complex Pilon fractures which were 14 of type Ⅱ and 9 of type Ⅲ according to Ruedi-Allgower Classification. Results All of the operations were performed safely. The average operative time was 57 min with average estimate blood loss of 75 ml. During the operation, no nerve or vascular injuries occured. Twenty-three cases were followed up for 6 to 24 months with an average of 17 months. No screw loosening or deep wound infection had occured. There were 3 cases with superficial pin tract infections cured through local dressing, 1 mild ankle inversion and 1 traumatic arthritis. Fracture union had been seen in all patients, with an average healing time of 4.2 months. According to Mazur ankle evaluation grading system, the results were excellent in 15 cases, good in 5 cases, fair in 2 cases and poor in 1 case, the excellent and good rate was 87.0%. Conclusions The method of manipulative reduction, dynamic external fixator and limited internal fixation is a good choice to reduce soft tissue injuries caused by open reduction and to aviod the destroy to blood supply of fracture site for the complex Pilon fractures with advantages of less blood loss, minimal invasion, shorter operative time and low fracture nonunion incidence.