摘要
目的:探讨应用解剖钢板内固定治疗52例高能量胫骨Pilon骨折的经验,并对本方法的治疗结果进行评估。方法:2005年8月～2008年2月共有52例患者接受本方法治疗,男性47例,女性5例。致伤原因以高处坠落为主,车祸次之。术前经7d～10d的跟骨牵引,抗炎,消肿。X线照片及部分伤者经CT三维重建明确诊断,采用踝前入路,显露胫骨远段及踝关节面,外侧切开显露外踝及腓骨远段。复位骨折及用克氏针临时固定,有必要时一定植入髂骨,X线透视见骨折复位满意后应用胫骨远端解剖钢板及松质骨螺丝钉固定骨折,术后石膏固定2～3周,练习踝关节,术后3个月持拐杖负重练习行走。结果:随访率100%,术后随访时间6～36个月,按(Phillips&Shwart踝关节评分)70～92分48例,4例小于70分。踝关节面获得完全解剖复位45例(87%),接近解剖复位7例(13%)。结论:牵引—复位—植骨—坚强内固定是分步延期ORIF治疗胫骨Pilon骨折成功的关键。应用解剖钢板内固定治疗高能量胫骨Pilon骨折能更好地恢复踝关节的解剖关系,牢固的内固定有利于踝关节早期活动。
Objective： To investigate and evaluate the internal fixation with anatomy plates for 52 case with high-energy tibia Pilon fractures.Methods：A total of 52 patients received the treatment from August 2005 to February 2008,47 males and 5 females.The main injury was caused by high altitude dropping and traffic accident.They were preoperative 7~10 days with the calcaneus traction,anti-inflammatory,and reduces swelling treatment.The patients were diagnosed based on X-ray and by CT of three dimensional reconstructing.Incision was made through anterior of ankle,the distal articulation surface of tibia was exposed and then the fracture fragments were fixed with Kirschner wire,and Ilium was planted if necessary.Internal fixated with anatomy plates and screws of cancellous bone when all the fractures were reduction satisfactory evaluated by X-ray,with plaster fixation 2~3 weeks postoperatively,exercised ankle and walked weight-bearing with crutch 3 months after surgery.Results： They were all followed up for 6 to 36 months.There were 48 cases with scores from 70 to 92,and 4 cases with scores less than 70.And there were 45 cases（87%） got anatomy reduction of articulation surface and 7 cases（13%） near anatomy reduction.Conclusion： Traction,reduction,plant the Ilium,and strong internal fixation were successful keys for the tibia pilon fracture.Internal fixation with anatomy plates for high energy tibia pilon fracture is a recommendable procedure for tibia pilon fracture for its advantages of speeding the postoperative recovery anatomy relation of ankle and fasting internal fixation for moving early of ankle.
出处
《中国中医骨伤科杂志》
CAS
2011年第11期27-28,共2页
Chinese Journal of Traditional Medical Traumatology & Orthopedics
