治疗骨骺未闭Pilon骨折的临床研究

目的探讨骨骺未闭Pilon骨折的特点、治疗方法、疗效及其并发症。方法对1999年6月-2005年9月间38例骨骺未闭Pilon骨折病例进行回顾性分析。按Merv-Letts分型:Ⅰ型11例,Ⅱ型20例,Ⅲ型7例。跟骨牵引、手法复位加小夹板外固定治疗12例;有限内固定17例;微创外支架固定(MIEFF)5例;有限内固定结合MIEFF固定4例。结果本组经随访8-60个月。按Helfet踝关节功能评价:优27例,良9例,差2例,优良率94.7%。并发症:皮肤坏死6例,MIEFF钉道松动2例,创伤性关节炎3例,畸形愈合2例,延迟愈合3例,骨骺早闭4例。总体并发症33.6%。结论骨骺未闭Pilon骨折,疗效与创伤程度及治疗方法密切有关,Ⅲ型骨折有较高的并发症,因此必须根据其分型采用不同治疗方法的治疗方案,从而减少了并发症的发生。

Study on the treatment of Pilon fracture of persistent epiphysis

Objective To investigate the features,therapeutic methods,curative effect and it's complications for Pilon fracture of persistent epiphysis.Methods From June 1999 to September 2005,38 cases with Pilon fracture of persistent epiphysis were analyzed retrospectively.According to Merv-Letts classification,the type I,II and III were in 11,20 and 7 cases repectively.Calcaneal skeletal tract,manual reduction plus small splint external fixcation were in 12 cases.Limited internal fixation was in 17 cases.Minimally invasive external stent fixation(MIEFF)was in 5 cases.Limited internal fixation combined with MIEFF was 4 cases.Results Follow-up time was from 8 to 60 months in the group.According to Helfet ankle joint function evaluation,the excellent,good and poor were 27,9 and 2 cases respectively.The excellent and good rate were 94.7%.Postoperative complications:skin necrosis was in 6 cases.MIEFF pin tract loosed was in 2 cases,delayed union 3 cases,malunion 2 cases,early closure of epiphysis 4 cases and arthritis 3 cases,Total complication rate was 33.6%.Conclusion The curative effects of Pilon fracture of persistent epiphysis are closedyrelated to traumatic degree and therapeutic methods.The type III fracture has a higher complications.So,according to it's classification,use of different therapeutic method is necessary to reduce the occurrence of complications.