62例Pilon骨折手术治疗体会.docVIP

62例Pilon骨折手术治疗体会 　　［摘要］目的： 手术治疗62例Pilon骨折的治疗效果。 方法：在生命体征平稳的情况下，予以治疗，合并其他部位损伤的患者均予以相应治疗，待生命体征平稳后再行手术。对于Ⅰ型骨折可采用石膏外固定6-8周，踝关节置于90°位。对于开放性骨折，均行急诊手术清创加单边多维外固定支架跨踝关节固定，有皮肤缺损者均采用植皮或皮瓣转移，尽可能Ⅰ期闭合创口，28例合并腓骨骨折(先行腓骨固定)，取经过腓骨骨折处小腿外侧切口，复位满意后，使用1/3管型板或重建钢板固定，合并胫腓联合分离的胫腓关节采用松质骨拉力螺钉固定。闭合性骨折胫、腓骨的2个皮肤切口间隔至少相距8cm，以防皮肤坏死和伤口哆开，注意防止胫前血液循环破坏。胫骨复位主要是恢复关节面的正常解剖，骨折复位后可行克氏针、螺钉固定，复位满意后使用胫骨远端解剖板、遵照AO内固定原则固定或单边多维外固定支架跨踝关节固定，对于骨缺损可行自体髂骨或同种异体骨植骨治疗。结果 采用Mazur评分系统评价手术效果。优40例，良16例，中4例，差2例，总优良率 93.22%。其中一期伤口愈合者54例，浅部感染6例，换药1周后痊愈，1外固定架钉道感染，3月骨折愈合后去除外固定架，4例延迟愈合，2例成角畸形愈合。结论 手术时机的正确选择，根据骨折类型和软组织条件，灵活选择固定方式是防治术后并发症、取得良好疗效的关键。 　　关键词：胫骨 ；Pilon骨折；内固定 　　中图分类号：R683 文献标识码：A 文章编号：1004-7484（2012）06-0151-03 　　[ Abstract ] Objective To summarize the operation method of Pilon fracture of tibia. Method in vital signs stable circumstances, be treated, with other sites of injury in patients are to be treated accordingly, to be vital signs stable after operation. For type I fractures using external fixation by plaster cast 6-8 week, the ankle in 90 degree position. For open fractures, underwent emergency operation debridement combined with unilateral external fixation across the ankle multidimensional stationary, with skin defect by skin graft or flap transfer, as far as possible primary closed wounds, 14 cases with fracture of the fibula ( first fixation of fibula ), and after fibular fracture lower leg lateral incision, satisfactory reduction, the use of 1 / 3 tube plate or reconstruction plate fixation, with tibiofibular syndesmosis separation tibiofibular joint with cancellous bone screw fixation. Closed fracture of tibia and fibula, 2 skin incisions spaced at least 8cm apart, to prevent skin necrosis and wound dehiscence, pay attention to prevent the tibialis anterior circulation failure. Reset is restoration of the articular surface of tibia in normal anatomy, fracture reduction feasible Kirschner wires, screws, satisfactory reduction after the use of anatomic distal tibial plate, locking plates in accordance w