三种方式治疗高能量Pilon骨折的临床评价

目的探讨三种方式治疗高能量Pilon骨折的临床效果,旨在提出最佳治疗方案.方法自1991年10月至1998年8月共收治高能量Pilon骨折51例,均属Ruedi和AlgowerⅢ型.按治疗方式可分为3组即采用AO苜蓿叶形钢板内固定22例,有限内固定结合"T"形超关节外固定回治疗15例;短期外固定架固定后改用钢板内固定14例(分两步)结果经6月～8年的随访发现三种治疗方法在临床疗效和并发症发生率上有明显差别,以短期超关节外固定架固定后二期用钢板内固定组疗效最佳.按Teeny和Wiss评分系统,其临床疗效优良率为78.6%,并发症发生率为28.5%.结论短期超关节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,显著减少伤口并发症及骨不连、延迟愈合等,治疗高能量Pilon骨折可取得满意效果,应视为治疗高能量pilon骨折的首选方法.

Three therapy concepts in severe fractures of the tibial pilon (a comparative study).

Objective To evaluate the clinic outcome of sev ere pilon fractures treated with thr ee methods individually and put forward the best treatment method.Methods From Oct.1991to Aug.1998,51patients suffered from severe pilon fracture were divided into three gro ups according to the fixation method s:22patients were treated primarily with internal fixation with plating of t ibia and fibula following the AO tech niques,15patients were treated with limite d internal fixation combined with ex ternal fixators,14patients were treated with a two -staged technique:Intern al fixation with a plate applied in a s econd step after initial reconstruction of the joint with minial internal fixation and short -term external transix ation with external fixator.Results After follow -up,the outcome and the complication had great difference a mong three groaps.The third group treated with two -staged technique g ot the best outcome,with the least complication.Conclusion A two -staged approach offers acceptable r esults for the treatment of severe pi lon fracture,could better resume an kle joint function and remarkably reduce various complications.So the authors consider that this method is the best me thod of treatment for severe pilon fractu re.