Pilon骨折39例治疗分析

目的探讨P ilon骨折治疗方法及影响疗效的相关因素。方法对2004年1月—2009年10月的39例P ilon骨折（Rued i-A llgower分型：Ⅰ型5例,Ⅱ型13例和Ⅲ型21例）中的6例采用非手术治疗,12例采用有限内固定结合外固定治疗,21例肿胀消退后切开复位内固定术,其中25例以植骨修补骨缺损。结果按照M azur评分标准,优14例,良21例,可3例,差1例。结论 P ilon骨折类型及周围软组织损伤程度对预后有重要影响。是否根据骨折分型及软组织条件选择合适的手术时机及合理的治疗方式、干骺端缺损区充分植骨,术后早行功能锻炼,晚负重是治疗成功的关键。

Diagnosis and treatment of pilon fracture in 39 cases

Objective To discuss and analyze the effect of the treatment of pilon fractures and its related factors.Methods Thirty-nine patients with pilon fracture（Ruedi-Allgower type Ⅰ of 5 cases,Ⅱ of 13 cases,Ⅲ of 21 cases） from January 2004 to October 2009 were treated,6 cases were treated by expectant treatment,12 cases were treated by combined external and limited internal fixation,21 cases were treated by open reduction and internal fixation after improvement of soft tissue conditions,25 cases were treated by bone transplantation.Results The function of ankle joint with Mazur system was evaluated： excellent of 14 cases,good of 21 cases,fair of 3 cases,bad of 1 case.Conclusion Type of pilon fracture and accurate assess local soft tissue condition are essential.According to pilon fracture type and degree of soft tissue injury,appropriate treat method and surgical opportunity can be selected.Metaphyseal bone defect area can be filled with transplanted bone to prompt restoration of articular surface.Early postoperative functional exercise and late weight-bearing can achieve better clinical efficacy.