Pilon骨折微创治疗体会

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1、Pilon骨折微创治疗体会［摘要］目的：探讨微创内固定手术治疗Pilon骨折的治疗效果。方法：2006至2009年间，共用微创手术治疗Pilon骨折24例，其中开放性骨折6例，12例患者行阶段性手术治疗，首先行腓骨骨折内固定术，胫骨骨折骨折外固定支架固定术，软组织条件允许后，关节前方小切口将胫骨关节面复位，小切口经皮植入薄型钢板固定胫骨关节面及干飯端骨折。结果平均随访17月（8-29月），2例患者出现内踝部皮肤坏死，均用皮肤牵张法治疗直至愈合，骨折愈合的时间平均14周（件24周）,没有骨折不愈合，没有出现内固定松动断裂，平均踝关节活动范围是30。（15°-50°）

2、,4例患者的患者出现了轻微的创伤性关节炎，4例有创伤性关节炎发生，只有1例患者即将行踝关节融合术，使用踝■后足评分，平均得分是88.6（66-100）,9例患者（37%）优秀,8例良（33%）,2例结果差（8%b结论微创手术植入薄型钢板手术与其他手术方法相比，能减低对周围软组织的损伤，结合阶段性的手术，是治疗Pilon骨折的理想手术方法。［关键词］Pilon骨折；钢板；微创植入[Abstract]Objective:Todeterminetheresultsofaminimallyinvasiveplatingtechniqueinthetreatmentofpi

3、lonfractures.Methods:Twenty-fourpatientswithpilonfracturesweretreatedbetween2006and2009withalow-proleplate・6fractureswereopen」nterventionStagedsurgicaltreatmentwithopenreductionandxationofthebularfractureandapplicationofanexternalxatorwasperformedin12cases.Assoonasthesofttissuesandswe

4、llingallowed,thearticularsurfacewasreconstructedandsimplyreduced,ifnecessarythroughansmallincision,andthearticularblockwasxedtothediaphysisusingapercutaneouslyintroducedplate.Intheremainingvecasestheoperationwasperformedinonesession.ResultsAtanaveragefollowupof17months(8-29months).AII

5、patientswentontobonyunionatanaveragetimeof14weeks(11-24weeks)・Therewerenoplatefailuresorlossofreduction.Twosupercialwound-healingproblemsresolvedwithlocalwoundcare.Nineofthepatientshadanklepain.Atthelatestfollowuptheaverageanklearcofmotionwas30°(15°-50°),ninepatients(37%)hadanexcellen

6、tresult;eight(33%)hadagoodresultwhereastwo(8%)hadapoorresult・Theaverageankle-hindfoot-scorewas86.8(66・100).onlyfourdevelopedanklearthritis・oneofthemisawaitingananklearthrodesis.Conclusionsitappearsthataminimallyinvasivesurgicaltechniqueineludinglowproleplatecandecreasesofttissueproble

7、mswhileleadingtofracturehealingandobtainingresultscomparablewithothermorerecentseries・Webelievethatthisminimallyinvasiveplatingtechniqueiseffectiveforthetreatmentofpilonfracturesandshouldbeusedinconjunctionwithastagedprocedureintheacutetraumasetting.[KeyWords]PilonFracturePlateMinimal

8、lyinv