一期外固定联合锁定钢板内固定术治疗C型pilon骨折的临床疗效

目的：探讨外固定架联合锁定钢板分期治疗C 型pilon 骨折的临床疗效。方法：选取2010 年3 月至2011 年4 月在我院接受治疗的C型pilon 骨折患者17 例。按照分期治疗的原则，先行一期外固定架固定术，待局部软组织恢复后切开复位，再行锁定钢板内固定术进行治疗，术后对患者进行一年的随访，定期检查患者的踝关节功能，并借助影像学资料对临床疗效进行评价。结果：全部患者获得随访，平均愈合时间为（4.1± 1.6）月；平均AOFAS 评分为（83.1± 12.4）分，其中优6 例（35.2 %），良8 例（47.1 %），一般2 例（11.8 %），差1 例（5.9 % ），优良率为82.4 %；术后4 例患者出现出现轻度感染，通过局部换药、抗生素和钉道护理得到控制。结论：采用一期外固定联合锁定钢板内固定术分期治疗C 型pilon 骨折，可以有效地提高治疗效果，值得临床推广。

Clinical Effects of External Fixation at One-stage Combined with Internal Fixation by Plate on the Treatment of Type C Pilon Fractures

Objective： To discuss the clinical efficacy of the external fixation at one-stage combined with locking plate internal fixation on the treatment of type C pilon fractures. Methods： 17 cases with type C pilon fractures who were treated by external fixation at one-stage combined with locking plate internal fixation in our hospital from March 2010 to April 2011 were selected. Based on the prin- ciples for type C pilon fractures, the patients were treated by the external fixation at the first stage till the local soft tissues were recovered completely, then performed the open reduction and internal fixation by locking plate. The patients were followed up for one year, the an- kle joint function of patients were examined regularly and the final outcomes of the treatment were evaluated with the help of the clinical rating and radiographic. Results： All the patients were available of follow-ups with the average time for healing of （4.1_＋ 1.6） months and the average score of AOFAS of（83.1＋ 12.4）. There were six cases excellent（35.2%）, eight cases good（47.1%）, two cases neutral（11.8%） and one case poor （5.9%） with the rate of 82.4%. The incidence of complication which including superficial infection in the wound with four patients who were successful treated by local dressing changes, the application of antibiotics and nail care. Conclusions： It is suggest- ed that the application of the external fixation at one-stage combined with internal fixation by locking plates could effectively improve the treatment effect.