摘要
目的 探讨胫骨Pilon骨折的外科治疗策略. 方法随访我院2005年5月-2008年3月治疗的47例Pilon骨折患者,其中男37例,女10例;年龄23～63岁,平均42.6岁.本组共47例51侧胫骨.致伤原因：交通伤34侧,坠落伤12侧,重物砸伤5侧.开放性骨折7侧,闭合性骨折44侧.根据Ruedi-Allgower分型标准：Ⅰ型6侧,Ⅱ型28侧,Ⅲ型17侧.软组织损伤根据Tscherne-Gotzen分度：开放性骨折1度2侧,2度3侧,3度2侧;闭合性损伤0度2侧,1度27侧,2度15侧.出于对内固定具体的选用,又将胫骨远端分为三柱：前外侧、前内侧及后侧柱.胫骨骨折采用Depuy的＂T＂形钢板18侧,AO三叶草钢板10侧,短＂T＂形钢板2侧,锁定钢板2侧,Link的前外侧解剖钢板4侧,Orthofix超踝关节外固定支架合并有限内固定15侧. 结果随访时间为12～44个月,平均23.2个月.踝关节功能按Mazur评分标准：优29侧,良13侧,可7例,差2侧,优良率为82%. 结论根据Ruedi-Allgower分型和软组织Tscherne-Gotzen分度选择手术时机和治疗方案,根据骨折累及胫骨远端三柱的情况选择合适的内固定,术后并发症少,可取得良好、满意的临床疗效.
Objective To explore the surgical treatment strategy for tibial pilon fractures.Methods Forty-seven patients with tibial pilon fractures surgically treated in our hospital from May 2005 to March 2008 were retrospectively studied. There were 37 males and ten females, at mean age of 42 years （range 23-46 years）. There were 51 sides of tibial pilon fractures, for four patients were with bilateral tibial pilon fractures. Injury causes included traffic accidents in 34 patients, fall from height in 12 and bruise by heavy objects in five. Open fractures were determined in seven patients and close fractures in 44 patients. According to Ruedi-Allgower classification, there were six sides of type Ⅰ fractures, 28 type Ⅱ fractures and 17 type Ⅲ fractures. According to Tscherna-Grotzen tissue injuries classification,open fractures were determined as 1° in two patients, 2° in three and 3° in two; close injuries were defined as 0° in two patients, 1° in 27 and 2° in 15. Distal tibia was partitioned as anterolateral column,anteromedial column and posterior column in order to select reasonable internal fixation. Eighteen fractures were treated with DePuy T plate, 10 with AO cloverleaf pattern plate, two with AO small T plate,two with locking plate, four with Link anterolateral anatomic plates and 15 with Orthofix overtake-anklejoint outside-fixed frame combined with limited internal fixation. Results The patients were followed up for a mean time of 23 months （range 12-44 months）. According to Mazur ankle evaluation grading system, 29 patients were graded as excellent, 13 good, seven fair and two poor, with an excellence rate of 82.4%. Conclusions Correct operation time and treatment plans on the basis of Ruedi-Allgower classification and Tscherne-Gotzen classifications of soft tissues and reasonable internal fixation according to the condition of the involved three column in distal tibia can decrease postoperative complications and achieve good and satisfactory clinical effect.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2010年第9期835-839,共5页
Chinese Journal of Trauma
关键词
胫骨骨折
骨折固定术
内
治疗结果
Pilon fractures
Fracture fixation,internal
Treatment outcome
作者简介
（杨正明，电话：13758228633，Email：eagle-my@163．com）
