手术治疗胫骨Pilon骨折43例临床分析

目的：探讨提高胫骨Pilon骨折临床疗效的方法。方法：对1999年5月～2007年12月在我院行手术治疗的胫骨Pilon骨折患者进行分析。采用Ruedi—Allgower分型：Ⅰ型4例、Ⅱ型16例、Ⅲ型23例，其中开放性骨折25例，闭合骨折18例。结果：所有病例均获随访6个月～6年，平均3．2年。根据Mazur踝关节症状和功能评分系统评估：优17例、良14例、可8例、差4例。优良率为72％。术后并发切口感染3例、踝内翻2例、慢性骨髓炎1例创伤性关节炎11例。结论：术前正确评估软组织损伤情况，选择合适手术时机、关节面解剖复位、适当有效固定、充分坚实植骨．积极合理地功能锻炼是提高疗效的有效方法。

Clinical Analysis of 43 Patients with Pilon Fracture Treated by Operation

Objective： To explore surgical treatment of Pilon fracture to increase the prognosis. Methods：43 cases of Pilon fractures were treated surgically in author＇s hospital from May 1999 to Dec 2007. Ruedi-Allgower typing was as following： 4 cases of type Ⅰ , 16 cases of Ⅱ , 23 cases of Ⅲ. In all, 25 cases were open fractures, while 18 were closed fractures. Results： Following up ranged from 6 months to 6 years, averaging 3.2 years. Result of Mazur scoring system was as following： 17 cases excellent, 14 cases good, 8 cases moderate, 4 cases bad, with good rate of 72%. Complications included 3 cases of wound infection, 2 cases of varus ankle, 1 case of osteomyelitis, 11 cases of traumatic arthritis. Conclusion：Evaluation of soft tissue, selecting of operation indication, anatomic reduction of articular surface, proper internal fixation and bone graft, and dirigation are critical factors to increase surgical effect.