Pilon骨折合并同侧跟骨骨折的治疗

目的 探讨Pilon骨折合并同侧跟骨骨折的治疗方法 . 方法 本组坠落伤7例,交通伤2例,重物砸伤1例,ISS评分为5～22分.开放性损伤7例,闭合性损伤3例.9例骨折达AO/OTA各分型中的2～3度,6例跟骨为关节内塌陷粉碎骨折.6例Pilon骨折行切开复位空心钉、螺钉或克氏针同定,其中4例加外固定架固定,跟骨骨折行撬拨复位克氏针或空心钉同定;2例单纯行跟骨骨折克氏针固定,2例两处骨折保守治疗. 结果 6例胫骨远端和跟骨骨折手术治疗者骨折对位改善;保守治疗者出现骨折成角畸形,关节面塌陷.7例伤几愈合良好,3例软组织愈合不良.4例随访患者踝-后足评分为82～94分. 结论 Pilon骨折合并同侧跟骨骨折为高能量暴力所致,局部软组织及骨组织损伤严重,有限内固定加外同定是比较适宜的治疗选择.

Management of ipsilateral Pilon and calcaneal fractures

Objective To analyze, treatment of ipsilateral Pilon and calcaneal fractures (IPCF). Methods Injury causes included fallings in seven patients, traffic injury in two and impact injury in one, with ISS score of 5-22 points. There were seven patients with open injuries and 3 with close ones. Nine pa-tients had Ⅱ-Ⅲ degree of Pilon fractures according to the AO/OTA classification and six comminuted com-pression calcaneal fractures according to the Essex-Loprest classification. The Pilon fractures were fixed by cannulated nail, screw or Kirschner wire through open reduction in six patients including four fixed with ex-ternal fixators (the calcaneal fractures were fixed with percutaneous eannulated nail or Kirschner wire by poking reduction). The calcaneal fractures were fixed with only Kirschner wire through poking reduction in two patients and double fractures treated conservatively in two. Results The reduction of Pilon and cal-caneal fractures treated by operation were markedly improved in six patients, while there occurred angular deformity and joint surface introeession in the patients treated conservatively. The wound healing of soft tis-sue was sound in seven patients but unsatisfactory in the other three. The ankle-hind foot score was 82-94 points in four patients who were followed up. Conclusions IPCF is caused by the high energy force and characterized by severe injures of the soft tissues and the bone tissues at the distal tibia and calcaneua, for which limited internal fixation plus external fixation are suitable treatment choice.