胫骨Pilon骨折手术治疗

目的 探讨牵引加石膏外固定、重建钢板内固定术、有限切开同时辅以外固定支架治疗Pilon骨折的疗效及其适应症。方法我院1998年2月～2008年3月107例患者接受该类方法治疗。根据Ruedi分型：Ⅰ型（无明显移位）35例，Ⅱ型（明显移位但关节面无粉碎）38例，Ⅲ型（胫骨远端粉碎性压缩骨折）34例。本组资料中，牵引＋石膏外固定组36例，重建钢板内固定组40例，有限切开同时辅以外固定支架组31例。结果107例Pilon骨折患者中，我们按Teeny等提出的评分标准评分，优49例，良32例，中16例，差10例。住院时间2～6周（平均3周），骨折愈合时间8～16周（平均12周）。结论根据骨折具体情况，软组织损伤程度及伤口开放情况选择不同的治疗方式。

Surgical treatment of tibial Pilon fracture

Objective To evaluate the choice of operative method, timing of surgery and the out-come of tibial Pilon fracture. Methods 107 patients with tibial Pilon fracture operatively treated between 1998 and 2008 were followed up. The average age was 45 years （ range from 16 to 68 years）. According to the Ruedi classification, there were 35 cases of type Ⅰ fracture, 38 cases type Ⅱ fracture and 34 cases type Ⅲ fracture. During operation, 36 patients were treated with calcaneal traction and plaster bandage, 40 patients had the fractures reduced and internal fixation done with plate, 31 patients were treated with limited internal fixation and external fixator. The average follow-up period was 21 months （ range from 9 to 48 months）. Results The results of the treatment were evaluated as Teeny criterion. 49 patients of them were excellent, 32 patients were good, 16 patients were fair, and 10 patients were poor. Conclusion In order to get a satisfactory result, it is important to have the right choice and timing of surgery and correct method of fixation in tibial Pilon fractures.