周华乔 陈金跃 邓伟 龚明洋 任相

[摘要] 目的 探讨在急诊情况下使用三维外固定架对Rüedi-AllgowerⅢ型Pilon骨折的关节面复位的临床研究。方法 方便选取该院2012年5月—2016年8月收治的Rüedi-Allgower Ⅲ型Pilon骨折的患者，在急诊早期使用三维外固定架进行骨折的复位；所有患者34例，其中男20例，女14例；年龄16～62岁，平均（42.6±0.2）岁；软组织条件允许后，二期行内固定手术治疗。采用评价骨折在影像学上复位标准的Burwell-Charnley標准和美国足踝外科协会AOFAS踝-足评分系统进行功能评价。结果 随访32例，2例失联，随访12～24个月，平均14个月，结果为Burwell-Charnley标准：关节面复位优良患者优20例，良12例，差2例。AOFAS踝-足评分系统（总分100分）：该组优25例，良4例，可3例。结论 在急诊情况下使用三维外固定架对Rüedi-Allgower Ⅲ型Pilon骨折的胫骨关节面复位有良好的效果，能帮助二期手术时关节面的复位，并能大幅度缩短二期内固定手术的手术时间，对骨折愈合及踝关节远期效果有明显的提高。

[关键词] Rüedi-AllowerⅢ型Pilon骨折；三维外固定架；关节面复位

[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2018）02（b）-0078-03

[Abstract] Objective This paper tries to investigate the clinical study of the reduction of the articular surface of the Rüedi-Allgower Ⅲ Pilon fracture using the three-dimensional external fixator in emergency. Methods From May 2012 to August 2016， 34 patients with Pilon fractures of Rüedi-Allgower type III in the early emergency using three-dimensional external fixator for fracture reduction； There were 20 males and 14 females， aged 16～62 years， with an average age of （42.6±0.2）years； After waiting for the soft tissue condition， the two stage was treated with internal fixation. We recorded the reduction of ankle joint surface， using Burwell-Charnley standard to evaluate fractures in the imaging reduction standard and AOFAS Ankle foot scoring system（total score 100 points）was used to evaluate. Results 32 cases were followed up， and 2 cases were of loss of association for 12 to 24 months， an average of 14 months， the results of the Burwell-Charnley criteria： superior surface reduction in patients with excellent in 20 cases， good in 12 cases and poor in 2 cases. AOFAS ankle - foot score system （total score of 100 points）： this group was excellent in 25 cases， good in 4 cases， and poor in 3 cases. Conclusion The use of three-dimensional external fixator in the emergency case of the Rüedi-Allgower Ⅲ Pilon fracture of the tibial articular surface reduction has a good effect， can help the second phase of the reduction of articular surface and can significantly shorten the two fixed surgery surgery Time， fracture healing and ankle joint long-term effect has been significantly improved.

[Key words] Rüedi-Allgower type III Pilon fracture； Three-dimensional external fixator； Articular surface reduction

Pilon骨折是胫骨远端的干骺端骨折累及踝关节的骨折，是一种关节内骨折，随着社会的发展，车祸及建筑伤增多，这种高能量损伤多为粉碎或压缩性骨折，关节面损伤严重[1]，大多数Pilon骨折需要手术处理，只有恢复了踝关节面及骨折长度，才能恢复踝关节功能，减少骨折引起的并发症，但对于关节面的复位是一个难题。该研究于2012年5月—2016年8月方便选取Rüedi-Allgower Ⅲ型[2]Pilon骨折的患者34例，在急诊早期使用三维外固定架进行骨折的复位固定，等待软组织条件允许后，二期进行内固定手术治疗；……