复杂Pilon骨折治疗方法的选择_临床医学论文.docVIP

复杂Pilon骨折治疗方法的选择_临床医学论文 复杂Pilon骨折治疗方法的选择_临床医学论文 作者：戴永平，丁健，卢弘栩，沈美文 【关键词】 ,Pilon骨折；,,骨折固定术；,,手术时机 　　摘要：目的：探讨Rüedi-AllgowerⅢ型Pilon骨折不同的治疗方法、手术时机及并发症的防治。方法：1999年8月至2006年2月收治Ⅲ型Pilon骨折患者25例，年龄22～65岁，平均37.8岁。开放性骨折9例，闭合性骨折16例，合并腓骨骨折21例。胫骨骨折钢板固定14例，螺钉加克氏针固定4例，外固定架结合有限内固定5例，踝关节融合2例。结果：术后随访6～80个月，平均37个月。按Mazur评分标准：优9例，良11例，中3例，差2例，优良率80%。结论：影响复杂Pilon骨折预后的因素很多，术前对损伤作出正确的评估，正确选择手术时机，选择合适的治疗方法是治疗成功的关键。 　　关键词： Pilon骨折； 骨折固定术； 手术时机 　　　Abstract： Objective： To discuss different procedures, time of surgery and prevention of complications for type Ⅲ Pilon fractures. Method： Follow-up were done for 25 patients with tibial Pilon fracture who had been treated in our department betweeb August 1999 and February 2006. Their average age was 37.8 years (ranging from 22 to 65 years). 9 cases were open fracture, and 16 cases were closed fracture. 21 cases were accompanied with fibular fracture. 14 cases of tibial fracture fixed with plate, 4 cases were treated with limited internal fixation with screw and Kirschner wire, 5 cases were treated with the external fixators combined with limited internal fixation and 2 cases with arthrodesis. Result： With the 6～80 months follow-up after the operation (average 37 months).According to Mazur’s criteria, the result was evaluated as excellent in 9 cases, good in 11 cases, fair in 3 cases and poor in 2 cases. The excellent and good recovery rate was 80%. Conclusion： Many factors can affect the prognosis of tibial Pilon fracture, the key points for a successful operation are careful assessment of the injury, right procedure and timing of surgery. 　　Key words： Pilon fracture; Fracture fixation; Postoperative treatment 　　 　　Pilon骨折是指胫骨远端波及关节面的骨折，1911年首先由Destot命名［1］。Pilon骨折约占下肢骨折的1%。近年来随着交通业和建筑业的发展，交通事故及坠落伤不断增多，高能量损伤的Pilon骨折发生率也随之增加，特别是Rüedi-AllgowerⅢ型Pilon骨折，其骨折粉碎严重、关节面塌陷以及往往伴有严重的软组织损伤，术后并发症多，治疗效果差。我科自1999年8月至2006年2月期间采用不同手术方法治疗Ⅲ型Pilon骨折25例，疗效满意。 　　1 资料与方法 　　1.1 一般资料：本组25例，男18例，女7例，年龄22～65岁，平均37.8岁。致伤原因：多处坠落伤17例，交通事故伤8例。按照Rüedi-Allgower分型均为Ⅲ型，即胫骨远端粉碎性压缩性骨折。合并