三种不同固定方式治疗Pilon骨折临床疗效比较

目的]评价切开复位接触性动力加压钢板（LC-DCP）、有限切开复位锁定钢板内固定（LCP）、有限切开复位有限内固定支架外固定（-OFS）治疗Pilon骨折的临床疗效.方法]回顾性分析2006年1月至2011年1月本院收治的胫骨Pilon骨折患者的临床资料.根据Rdi-Allgwer分型Ⅱ型51例,Ⅲ型10例;应用LC-DCP方法治疗18例,LCP治疗21例,OFS治疗22例.应用MAZUR评分系统对上述三组进行踝关节功能评定.结果]术后随访12~36个月,平均（12.3±3）个月,全部骨折愈合.LC-DCP组：踝关节功能评定优7例,良8例,可2例,差1例,优良率为83.3%;LCP组优9例,良9例,可2例,差1例,优良率为85.7%;OFS组：优9例,良10例,可2例,1例差,优良率为86.3%.三组优良率比较差异无统计学意义（P〉0.05）.结论]对于Rdi-Allg werⅡ、Ⅲ型胫骨Pilon骨折根据软组织损伤情况,低能量损伤采用LC-DCP或LCP方法.对于高能量,开放性损伤者采用彻底清创、骨折复位,有限内固定加支架外固定可以降低手术后并发症,取得满意疗效.

Comparison of Clinical Efficacy of Three Different Fixation Methods for the Treatment of Pilon Fracture

ObjectivelTo evaluate the clinical efficacy of open reduction and low-contact dynamic compression plate （LC-DCP）, finite open reduction and locked plate（LCP）, finite open reduction and internal fixation combined with stent external fixation（OFS） for the treatment of Pilon fracture. Methods] Clinical data of tibial Pilon fracture admitted to our hospital from Jan. 2006 to Jan. 2011 were analyzed retrospectively. According to R6di-Allgower classification, 51 cases were type II and 10 cases were type III. Eighteen patients underwent LC-DCP. Twenty one patients underwent LCP. Twenty two patients underwent OFS. MAZUR score system was used to evaluate ankle joint function in above three groups. Results] All patients were followed up for 12-36 months with the average of （12.3±3） months. All fractures were healed. According to ankle joint function assessment, 7 cases were excellent, and 8 cases were good, and 2 cases were general, and one case was poor in LC-DCP group, and the good and excellent rate was 83.3%. In LCP group, 9 ca- ses were excellent, and 9 cases were good, and 2 cases were general, and one case was poor, and the good and excellent rate was 85.7%. In OFS group, 9 cases were excellent, and 10 cases were good and one case was poor, and the good and excellent rate was 86.3%. There was no significant difference in the good and excellent rate among three groups（ P 〉0.05）. Conclusion] For patients with ROdi-AllgOwer type Ⅱ and Ⅲ Pilon fracture, the surgical methods should be chosen according to the degree of soft tissue injury. LC-DCP or LCP are used for low energy injury. Thorough debridement, open reduction, finite internal fixation and stent external fixation for the treatment of the patients with high energy injury can reduce postoperative complications and has satisfactory result.