解剖型钢板和锁定钢板内固定修复胫骨远端Pilon骨折

背景：Pilon骨折切开复位内固定的难点在于关节面的重建和软组织保护,解剖型钢板和锁定钢板具有三维固定等优点,与以往普通固定材料相比有一定优势。目的：探讨解剖型钢板和锁定钢板的结构特点以及在胫骨远端Pilon骨折关节面解剖复位的疗效。方法：对2004-03/2010-08收治的79例Pilon骨折患者进行回顾性研究,其中开放性损伤22例,闭合性损伤57例,Ruedi-AllgowerⅡ型31例,Ⅲ型48例;部分开放性损伤者行急症处理,闭合性损伤者于伤后7～12d进行切开复位内固定;根据骨折的不同形态和软组织损伤情况,分别采用切开复位解剖型钢板和锁定钢板内固定,或胫骨外固定支架固定。结果与结论：所有患者均获得4～19个月随访,应用Tornetta评分系统评估治疗效果,Ruedi-AllgowerⅡ型优良率为97%,Ruedi-AllgowerⅢ型优良率为79%;Ruedi-AllgowerⅢ型患者中,行切开复位内固定患者的优良率达88%,支架外固定患者关节功能恢复均不满意;外固定者创面均有浅部感染及部分软组织坏死,经对症处理全部愈合,未发生骨髓炎及骨不愈合情况。结果可见应用解剖型钢板和锁定钢板内固定治疗胫骨远端Pilon骨折疗效理想,治疗要点在于保留软组织覆盖和重建稳定的关节面。

Anatomy type steel plate versus lock plate fixation for tibial Pilon fracture

BACKGROUND：The difficulty of Pilon fractures with open reduction and internal fixation is the reconstruction of the articular surface and soft tissue protection,compared with the ordinary fixation material,the anatomy type steel plate and lock plate have the advantage of three-dimensional fixation.OBJECTIVE：To investigate the structural characteristics of anatomical plate and lock plate as well as the curative effect on anatomical reduction of the articular surface of the distal tibial Pilon fractures.METHODS：Retrospective study was performed on 79 Pilon fracture cases from March 2004 to August 2010,including 22 cases of open injury,57 cases of blunt trauma,31 cases of Ruedi-Allgower type Ⅱ and 48 cases of Ruedi-Allgower type Ⅲ;partly open injured patients were operated urgently,the blunt trauma patients accepted open reduction and internal fixation at 7 to 12 days after injury.According to the different fracture morphology and soft tissue injury,open reduction internal fixation,lock plate fixation and tibia external fixation treatment were performed respectively.RESULTS AND CONCLUSION：All the patients obtained the 4-9 months follow-up and the treatment effects were evaluated by Tornetta scoring system,97% excellent and good rate in Ruedi-Allgower type Ⅱ,and 79% in type Ⅲ.Patients of type Ⅲ accepted open reduction internal fixation surgery reached 88% good rate.The frame external fixation patients were dissatisfied with the function recovery.For the patients with external fixation,some skins were superficial infected and the soft tissue was necrosis,and all the infection patients were recovered after treatment,and there were no osteomyelitis and nonunion appeared.To treat Pilon fracture with anatomy type steel plate or lock plate has an ideal effect,the main points of the treatment is to retain the soft tissue coverage and to reconstruct a stable articular surface.