外固定支架在高能量Pilon骨折分期治疗中的地位和意义探讨_临床医学论文.docVIP

外固定支架在高能量Pilon骨折分期治疗中的地位和意义探讨_临床医学论文 外固定支架在高能量Pilon骨折分期治疗中的地位和意义探讨_临床医学论文 【摘要】 Pilon骨折常常是一种高能量损伤。约1／3～1／2的Pilon骨折伴有其他骨折或脏器损伤。10％～30％的Pilon骨折为开放性骨折。本文探讨使用外固定支架分期治疗高能量Pilon骨折的意义。［方法］从2004年2月～2007年3月共收治10例高能量Pilon骨折患者，男8例，女2例，年龄22～72岁，平均56.2岁。初期治疗选用单臂外固定支架(Orthofix)以及Hoffmann外固定支架(Stryker)。待患者全身情况好转、创面愈合或软组织条件改善后，再转换为切开复位内固定或微创闭合内固定(MIPPO)。［结果］10例患者平均外固定支架使用时间为13.2(7～49) d，均转换为坚强内固定治疗。软组织开放伤口和手术伤口均获得愈合，所有病例均获得骨性愈合，无骨筋膜室综合征、骨髓炎发生。1例开放性Pilon骨折外固定后发现感染，在抗菌治疗后7周更换内固定，同时放置庆大霉素珠链，术后骨折愈合。［结论］对于高能量Pilon骨折，正确评估局部软组织条件和全身情况，合理使用外固定支架进行损伤控制，适当时机更换内固定的分期治疗办法是安全有效的。 【关键词】 外固定支架 Pilon骨折 分期治疗 Abstract：［Objective］Pilon fractures are often high～30% Pilon injuries are open fractures.This study was aimed to evaluate the significance of external fixator in the multi［Method］Ten patients(M=8,F=2) with highrs).All patients underwent external fixation of singlearm external fixator (Orthofix)or Hoffmann external fixatorII (Stryker) in the very early stage.Then it was replaced by strong internal fixation through open reduction or close reduction with the technique of minimally invasive percutaneous plate oesteosynthesis (MIPPO) when general conditions were controlled,the wound surface healed and the soft tissues improved.［Result］The mean duration of external fixation was 13.2 days (range 7-49 days).All the external fixations were changed to internal fixations.All the traumatic and operative wounds healed.All bone fractures united.No compartment syndrome or osteomyelitis occurred in this study.One case of open Pilon fracture was found infection after external fixation.It was changed to internal plate fixation after 7 weeks of antiinfection treatment.The infection was controlled and the bone reunited.［Conclusion］For highsue injuries and general conditions,proper damage control via external fixator,and right timing to change to internal fixator,is safe and effective. Key words：external fixator; Pilon fracture; multi Pilon骨折常常是一种高能量损伤。约1／3～1／2的Pilon骨折伴有其他骨折或脏器损伤。10％～30％(一些报道高达50％)的Pilon骨折为开放