Pilon骨折24例手术治疗临床分析.doc

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1、Pilon骨折24例手术治疗临床分析【摘要】目的探讨II型、111型Pilon骨折的于•术治疗方法，进一步提高疗效。方法2002年1月〜2006年12月收治24例II型、III型Pilon#折。根据RUediAllgower分型,II型11例，III型13例。开放性骨折8例，英中有7例急诊即行淸创骨折复位内固定术，1例急诊清创跟骨牵引，20天后II期行骨折复位内固定术；闭合性骨折16例均于伤后4〜15天(平均9.25天)行骨折切开复位内固定术。术后有步骤地进行主动+被动踝关节功能锻炼。结果本纽有20例获随访，随访时间8〜21个月，平均15.7个月。按BurwellChamley

2、(1965)放射学评价标准：解剖复位11例可10例,差3例,优良率为87.5%。&Tometta等(1993)评价标准评价：优9例，良7例，可2例，差2例，优良率为80%o结论Pilon#折是踝部常见的关节内骨折，在手术时机的选择上，我们主张适度延期于•术，于术入路、固定方法应个体化决定，同时耍注意微创操作原则，减少术后并发症的发生，术后有步骤地进行主动+被动踝关节功能锻炼，使踝关节功能得到最大程度的恢复。【关键词】骨折关节复位内固定Clinicalanalysisof24caseswithPilonfracturestreatedbyopenreductionandinter

3、nalfixationZHAOJinmin,TANZhen,SUWei(DepartmentofOrthopaedicTraumaSurgery,FirstAffiliatedHospitalofGuangxiMedicalUniversity,Nanning530021,China)Abstract：ObjectiveTosummarizetheclinicaldataofthetreatmentoftypeIIandtypeIIIPilonfractures,andinvestigatethetreatmentoftypeIIandtypeIIIPilonfractures

4、toguidetheclinicalwork.MethodsFromJan.2002toDec.2006,ourdepartmenthadtreatedatotalof24caseswithPilonfracturesoftypeIIandtypeIII.AccordingtotheRüediAllgowerclassificationofPilonfracture,therewere11oftypeIIand13oftypeIILSixteenofclosefractureswereadoptedopenreductionandinternalfixationin4

5、to15daysafterwounded,average9.25days.Sevenof8openfractureswereprimarilyclearedatfirstandcalcaneustractionwasused,thenopenreductionandinternalfixationafter20days.Initiative+passiveanklefunctionexercisewasprocessedafteroperation.ResultsTwentycaseswerefollowedup8to21months,average15.7months.Eva

6、luatedbytheBurwellCharnley(1965)pilonfracturereductionradiologyscore:11caseswereanatomizereductionand10werefunctionreduction,theexcellentandgoodratewas87.5%andtheTonietta(1993)Pilonfractureclinicaltreatmentscore:9wereexcellent,?weregood,theexcellentandgoodratewas80%.ConclusionPilonfractureis

7、acommonintraarticularfracture.Werecommend:1.Relatedoperationandtheapproachofoperationshouldbedecidedaccordingtothepositionofthemainfractureblock.2・ThefracturewasfixedbyplateorlimitedbyscrewsandKirscherwiresaccordingtothedamagelevel.3.Weadopttherule