延期切开复位植骨钢板内固定治疗Pilon骨折

目的探讨延期切开复位结合植骨三叶草钢板内固定治疗Pilon骨折的疗效。方法 26例Pilon骨折患者,6例为开放性骨折,20例为闭合性骨折,对闭合性骨折先行跟骨牵引治疗,待肿胀消退后行切开复位结合植骨三叶草钢板内固定治疗。结果 26例均获术后随访,随访时间842个月。骨折临床愈合时间为1628周,患肢力线正常。术后有3例伤口感染,3例皮肤坏死,5例踝关节功能障碍;未见有骨折不愈合或畸形愈合,无窦道形成及骨髓炎。临床疗效按美国足与踝关节协会踝与后足功能评分：优6例（90100分）,良14例（7589分）,可3例（5074分）,差3例（小于50分）。结论正确评估局部软组织条件,根据Pilon骨折的类型和软组织损伤程度选择合适的手术方式和手术时机,三叶草钢板内固定维持骨折复位和下肢力线,干骺端缺损区充分植骨,修复关节面,早期功能锻炼,晚负重,可使P ilon骨折术后达到良好的临床疗效。

Delayed Open Reduction and Clover Plate Internal Fixation Combined with Bone Grafting for Pilon Fractures

Objective To discuss the clinical efficacy of delayed open reduction and clover plate internal fixation combined with bone grafting for the treatment of Pilon fractures.Methods A total of 26 cases of Pilon fractures were treated by open reduction and clover plate internal fixation combined with bone grafting after improvement of soft tissue conditions,including 6 cases of open Pilon fractures and 26 cases of closed fractures.Results All the patients were followed up,ranged from 8 to 42 months.The time of fracture healing ranged from 16 to 28 months.Mechanical axis of low limb was normal.In these patients,complications followed with wound infection in 3 cases,skin necrosis in 3 cases and functional disturbance of ankle in 5 cases.Nonunion,malunion,Sinus formation,osteomyelitis and deep infection were no found.According to American Foot and Ankle Society（AOFAS） ankle and hind foot function score,the functional results of ankle included 6 excellent（90～100 minutes）,14 good（75～89 minutes）,3 fair（50～74 minutes）,3 bad（〈50 points）.Conclusion Accurate assess local soft tissue conditions for Pilon fractures.According to Pilon fracture type and degree of soft tissue injury,appropriate surgical method and surgical opportunity were selected.clover plate internal fixation combined with bone grafting maintain fracture reduction and mechanical axis of lower limb.Metaphyseal bone defect area filled with autogenous bone or artificial bone prompt restoration of articular surface.Early functional exercise and late weight-bearing can promote Pilon fractures to achieve good clinical efficacy.