Pilon骨折微创治疗体会.docVIP

Pilon骨折微创治疗体会 　　【摘要】目的 探讨微创内固定手术治疗Pilon骨折的治疗效果。方法 2006至2009年间，共用微创手术治疗Pilon骨折24例，其中开放性骨折6例，12例患者行阶段性手术治疗，首先行腓骨骨折内固定术，胫骨骨折骨折外固定支架固定术，软组织条件允许后，关节前方小切口将胫骨关节面复位，小切口经皮植入薄型钢板固定胫骨关节面及干骺端骨折。结果 平均随访17月（8-29月），2例患者出现内踝部皮肤坏死，均用皮肤牵张法治疗直至愈合，骨折愈合的时间平均14周（11-24周），没有骨折不愈合，没有出现内固定松动断裂，平均踝关节活动范围是30°（15°-50°），4例患者的患者出现了轻微的创伤性关节炎，4例有创伤性关节炎发生，只有1例患者即将行踝关节融合术，使用踝-后足评分，平均得分是88.6（66-100），9例患者（37%）优秀， 8例良（33%），2例结果差（8%）。结论 微创手术植入薄型钢板手术与其他手术方法相比，能减低对周围软组织的损伤，结合阶段性的手术，是治疗Pilon骨折的理想手术方法。 　　【关键词】Pilon 骨折，钢板 微创植入 　　中图分类号：R687.3 文献标识码：A 文章编号：1005-0515（2012）2-009-02 　　Minimally invasive treatment of pilon fractures 　　Liang Qinghuai He Daohui 　　（Department of Orthopaedic Surgery , Dalang Hospital of dongguan city , Guangdong 523770,china） 　　【Abstract】Objective To determine the results of a minimally invasive plating technique in the treatment of pilon fractures.Methods Twenty-four patients with pilon fractures were treated between 2006 and 2009 with a low-prole plate. 6 fractures were open.Intervention Staged surgical treatment with open reduction and xation of the bular fracture and application of an external xator was performed in 12 cases. As soon as the soft tissues and swelling allowed,the articular surface was reconstructed and simply reduced, if necessary through an small incision, and the articular block was xed to the diaphysis using a percutaneously introduced plate. In the remaining ve cases the operation was performed in one session. Results At an average follow up of 17 months （8-29months）.All patients went on to bony union at an average time of 14 weeks（11-24weeks）. There were no plate failures or loss of reduction. Two supercial wound-healing problems resolved with local wound care. Nine of the patients had ankle pain. At the latest follow up the average ankle arc of motion was 30°（15°-50°），nine patients (37%)had an excellent result; eight (33%)had a good result whereas two （8%）had a poor result. The average ankle-hindfoot-score was 86.8 (66-100). only four developed ankle ar