有限内固定联合外固定支架治疗高能量胫骨Pilon骨折

目的介绍有限内固定联合外固定支架治疗高能量胫骨Pilon骨折的经验和对其疗效进行评估。方法自2000年10月～2008年3月31例患者接受该方法治疗。该手术采用踝前内侧和外侧切口，暴露胫骨远端关节面和外侧腓骨，以螺钉或克氏针固定胫骨，重建钢板或克氏针固定腓骨，外固定支架的近侧螺钉置于胫骨骨折近端，远侧螺钉置于跟骨和距骨颈上。对31例高能量胫骨Pilon骨折进行随访，按Ruedi分型：Ⅰ型6例，Ⅱ型11例，Ⅲ型14例。结果采用Teeny等评分系统评估手术疗效，优17例（54．8％），良10例（32．2％），中2例（6．5％），差2例（6．5％）。结论有限内固定结合外固定支架治疗高能量胫骨Pilon骨折显著减少伤口并发症及骨不愈合、延迟愈合，能较好地恢复踝关节功能，该术式可作为治疗高能量胫骨Pilon骨折的首选方法。但仍有螺丝钉松动，钉道感染等并发症。

The treatment of high energy tibial Pilon fractures with limited internal fixation and external fixator

Objective To report our experience in managing the high energy tibial Pilon fractures and evaluate the operative results for patients who were treated with limited internal fixation and external fixators. Methods Thirty-one high energy tibial Pilon fractures were treated with limited internal fixation and external fixator from October 2000 to March 2008. The average followed-up period was 22 months （range 10 to 48 months）. The proximal two pins of external fixator were inserted into the proximal portion of tibia fracture line. The distal two pins were inserted into the neck of the talus and the tuberosity of the caicaneus. According to the Ruedi classification, there were 6 cases of type I fi＇acture, 1 lcases type II fracture, 14 cases type III fracture. Results The results of the treatment were evaluated as Teeny criterion. 17 patients of them were excellent, 10 patients were good, 2 patients were fair, and 2 patients were poor. Conclusion The treatment of limited internal fixation combined with external fixators helps to effectively decrease delayed union, nonunion and wound healing complications, and resume ankle joint function postoperatively. R is a satisfactory method to treat the high energy tibial Pilon fractures.