手术治疗Pilon骨折的难点及对策

摘要：目的 探讨Pilon骨折的手术治疗难点及对策。 方法 手术治疗88例Pilon骨折患者。闭合性骨折41例，开放性骨折47例。开放性骨折根据不同的骨折类型和软组织损伤情况选择不同治疗方法。术后比较开放性骨折和闭合性骨折手术治疗效果进行及不同Gustilo分型的治疗效果。 结果 本组所有患者均得到随访，平均随访时间14-29（22.4±6.57）月，采用Mazur踝关节症状与功能评分系统评价：优31例，良35例，可17例，差5例。开放性骨折优良率61.7%，闭合性骨折优良率。90.2%。两种骨折治疗结果差异明显（P﹤0.05）。开放性骨折GustiloⅡ型优良率71.8%；ⅢA 型优良率45.4%；ⅢB型优良率25.0%，统计学比较差异有意义（P﹤0.05）。 结论 软组织处理和骨折复位程度是治疗Pilon骨折的关键。

Difficulties and Countermeasures of the surgical treatment of Pilon fractures

Objective To discuss difficulties and countermeasures of the surgical treatment of Pilon fractures.Methods Eighty-eight pilon fractures were treated Ruedi-Allgower classification:4 cases of type Ⅰ,31 cases of type Ⅱ,53 cases of type Ⅲ.47 cases of open fractures.41 cases of close fractures.The 41 fracture with soft tissue damage were classified according Gustilo classification:32cases of type Ⅱ,11cases of type ⅢA,4 cases of type ⅢB.Choose a different treatment according to the different types of fractures and soft tissue injuries.Results All patients were followed with an average of 22.4±6.57 months(14-29 months).According to The Mazur ankle symptoms and functional scoring system:31 cases excellent,35 cases good,17 cases fair,5 cases poor.Excellent rate of open fractures was 61.7%,Excellent rate of close fractures was 90.2%.Excellent rate in Patients with soft tissue damage of Gustilo typeⅡ was71.8%;Excellent rate of type ⅢA was 45.4;Excellent rate of type ⅢB was 45.4.Conclusion Soft tissue and fractures extent is the key to the treatment of Pilon fractures.