Pilon骨折的微创治疗体会(1)
[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
[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 arthritis. one of them is awaiting an ankle arthrodesis.Conclusions it appearsthat a minimally invasive surgical technique including low prole plate can decrease soft tissue problems while leading to fracture healing and obtaining results comparable with other more recent series. We believe that this minimally invasive plating technique is effective for the treatment of pilon fractures and should be used in conjunction with a staged procedure in the acute trauma setting.
[Key Words] Pilon Fracture Plate Minimally invasive Plating
Pilon骨折为高能量伤所致的胫骨远端关节面上干骺骨折，伴有关节面的粉碎、分离，压缩，干骺端粉碎性骨折，范围可累及内外踝、后踝的骨折，常伴有软组织严重损伤。我院自2006年1月至2009年11月共采用微创手术治疗pilon骨折24例，取得较好的疗效，现报道如下：
1 临床资料
1.1一般资料
本组24例，男20例，女4例；年龄24～57岁，平均38.3岁。高空坠落伤16例，交通伤5例，重物压伤3例。开放性骨折6例。闭合性骨折18例。按Rüedi-分型I型5例，II型5例，Ⅲ型14例。AO分级为C1型5例，C2型8例，C3型骨折11例，20例合并同侧腓骨骨折，5例合并其他损伤，2例患者合并颅脑闭合性损伤，同侧股骨骨折，同侧的坐骨神经麻痹。2例患者合并对侧的跟骨骨折，1例患者合并同侧的胫骨平台骨折并出现小腿骨筋膜室综合症。, 百拇医药(杨鹏飞)
[关键词] Pilon骨折；钢板；微创植入
[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 arthritis. one of them is awaiting an ankle arthrodesis.Conclusions it appearsthat a minimally invasive surgical technique including low prole plate can decrease soft tissue problems while leading to fracture healing and obtaining results comparable with other more recent series. We believe that this minimally invasive plating technique is effective for the treatment of pilon fractures and should be used in conjunction with a staged procedure in the acute trauma setting.
[Key Words] Pilon Fracture Plate Minimally invasive Plating
Pilon骨折为高能量伤所致的胫骨远端关节面上干骺骨折，伴有关节面的粉碎、分离，压缩，干骺端粉碎性骨折，范围可累及内外踝、后踝的骨折，常伴有软组织严重损伤。我院自2006年1月至2009年11月共采用微创手术治疗pilon骨折24例，取得较好的疗效，现报道如下：
1 临床资料
1.1一般资料
本组24例，男20例，女4例；年龄24～57岁，平均38.3岁。高空坠落伤16例，交通伤5例，重物压伤3例。开放性骨折6例。闭合性骨折18例。按Rüedi-分型I型5例，II型5例，Ⅲ型14例。AO分级为C1型5例，C2型8例，C3型骨折11例，20例合并同侧腓骨骨折，5例合并其他损伤，2例患者合并颅脑闭合性损伤，同侧股骨骨折，同侧的坐骨神经麻痹。2例患者合并对侧的跟骨骨折，1例患者合并同侧的胫骨平台骨折并出现小腿骨筋膜室综合症。, 百拇医药(杨鹏飞)