王沛+张海峰

[摘要] 目的 研究对于延期的Pilon骨折，选取锁定加压接骨板进行骨折固定，观察其治疗效果。方法 方便选取该院2013年3月—2016年3月收治的22例患者，骨折部位通过使用跟骨牵引进行暂时稳定，维持固定后8～16 d，平均11.6 d，待骨折周围的组织条件改善后，行切开复位锁定加压接骨板内固定，治疗Pilon骨折22例，男13例，女9例；年龄18～55岁，平均36岁；依据Ruedi-Allgower骨折分型：Ⅱ型16例，Ⅲ型6例。疗效评定标准采用Mazur等制定的踝关节症状与功能评分系统。结果 所有患者都得到完整随访，时间1～3年，平均1.6年。优12例，良6例，可2例，差1例，优良率85.7%。全部患者在手术治疗后骨折得到完全愈合，愈合时间为3～5个月（平均4.2个月）。术后并发症：发生切口或者局部皮肤坏死的患者有2例，给以定期换药及营养支持治疗后伤口愈合良好。结论 待患者骨折周圍软组织恢复后，选取锁定加压接骨板治疗Pilon骨折，最终获得了良好的临床治疗效果，有效降低了手术后的相关并发症，可以作为一种富有成效的治疗手段应用于临床。

[关键词] Pilon骨折；锁定钢板；延期

[中图分类号] R683.42 [文献标识码] A [文章编号] 1674-0742（2017）02（b）-0088-03

[Abstract] Objective To research the effect of postponed Locking Compression Plates in treatment of Pilon fracture. Methods The fracture sites were for the temporary stabilization by using the 22 cases bone traction in our hospital from March 2013 to March 2016， and were treated with open reduction locking compression plate internal fixation after the improvement of tissue condition around fractures， and 22 cases of patients with Pilon fracture， including 13 cases of males and 9 cases of females were treated， and the age was from 18 to 55 and the average age was 36， and there were 16 Ⅱ type and 6 Ⅲ type according to the Ruedi-Allgower fracture classification， and the curative effect was evaluated according to the ankle joint symptom and function score system made by Mazur. Results All patients were followed up for 1 to 3 years， and the average age was 1.6， and there were 12 excellent cases， 6 good cases， 2 fair cases and 1 poor case， and the excellent and good rate was 85.7%， and all patients were completely cured after the operation treatment， and the cure time was between 3 months to 5 months （the average month was 4.2）， and there were 2 cases with incision or local skin necrosis， and the wound is cured after the regular dressing and nutrition support therapy. Conclusion After the recovery of soft tissues around fractures of patients， the Locking Compression Plates in treatment of Pilon fracture can obtain a good clinical treatment effect finally and effectively reduce the related complications after operation， which can be used a kind of fruitful treatment means in clinic.

[Key words] Pilon fracture； Locking plate； Postponed

胫骨Pilon骨折是创伤骨科的一种常见损伤，其发生率约占下肢骨折的1%，胫骨骨折的3%～10%[1]。患者骨折后，多有骨折周围严重的软组织损伤，有时伴随粉碎的干骺端或关节面，骨折线向近端延伸。在临床工作中，有很大的治疗困难，有很多原因会导致骨折的最终治疗效果，在治疗过程中，许多医生存在着不同的观点和经验。随着运输业、工程机械及建筑业的发展，多种交通损伤和坠落伤频繁发生，导致Pilon骨折的发生率逐年增高[2]。……