CAJ | 학술논문

目的：探讨外固定架与切开复位内固定治疗 Ruedi-AllgowerⅢ型 Pilon骨折的疗效。方法将31例Ruedi-AllgowerⅢ型Pilon骨折患者按手术方法不同分为外固定组(14例)和切开复位内固定组(17例)。参照美国足踝外科协会( AOFAS)评分评价疗效，记录踝关节活动范围和并发症情况。结果外固定组随访时间6~24个月；AOFAS评分70~90分，其中优1例，良9例，可4例；踝关节背伸12.5°~18.2°；术后发生表浅坏死4例，创伤性骨关节炎14例。切开复位内固定组随访时间6~26个月；AOFAS评分72~92分，其中优2例，良10例，可5例；踝关节活动背伸13.2°~20.1°；术后发生表浅坏死5例，创伤性骨关节炎17例。两组患者AOFAS评分、踝关节活动范围、并发症发生率及创伤性骨关节炎发生率比较差异均无统计学意义( P>0.05)。结论外固定架与切开复位内固定治疗Ruedi-AllgowerⅢ型Pilon骨折临床疗效无差别。外固定架更适合软组织条件差的患者；切开复位内固定更适合软组织条件好的患者。
목적：탐토외고정가여절개복위내고정치료 Ruedi-AllgowerⅢ형 Pilon골절적료효。방법장31례Ruedi-AllgowerⅢ형Pilon골절환자안수술방법불동분위외고정조(14례)화절개복위내고정조(17례)。삼조미국족과외과협회( AOFAS)평분평개료효，기록과관절활동범위화병발증정황。결과외고정조수방시간6~24개월；AOFAS평분70~90분，기중우1례，량9례，가4례；과관절배신12.5°~18.2°；술후발생표천배사4례，창상성골관절염14례。절개복위내고정조수방시간6~26개월；AOFAS평분72~92분，기중우2례，량10례，가5례；과관절활동배신13.2°~20.1°；술후발생표천배사5례，창상성골관절염17례。량조환자AOFAS평분、과관절활동범위、병발증발생솔급창상성골관절염발생솔비교차이균무통계학의의( P>0.05)。결론외고정가여절개복위내고정치료Ruedi-AllgowerⅢ형Pilon골절림상료효무차별。외고정가경괄합연조직조건차적환자；절개복위내고정경괄합연조직조건호적환자。
Objective To investigate the effect of Ruedi-AllgowerⅢPilon fracture with external fixation and open re-duction and internal fixation. Methods Patients who were diagnosed high-energy injury Ruedi-Allgower Ⅲ Pilon fracture were analyzed retrospectively. 14 patients were treated with external fixation(EF), 17 patients were treated with open reduction and internal fixation ( ORIF ) . According to the American Foot and Ankle Surgeons ( AOFAS ) score, ankle range of motion, complications were recorded. Results Patients who were treated with EF were availa-ble for following up 6~24 months,whose AOFAS score was 70~90 points ( excellent in 1 case, good in 9 cases, fair in 4 cases) and ankle dorsiflexion was 12. 5°~18. 2°. 4 patients had superficial necrosis. 14 patients had traumatic osteoarthritis. ORIF patients were available for following up 6~26 months, whose AOFAS score was 72~92 points (excellent in 2 cases, good in 10 cases, fair in 5 cases) and ankle dorsiflexion was 13. 2° ~20. 1°. 5 patients had superficial necrosis. 17 patients had traumatic osteoarthritis. It wasn’t found differences across AOFAS score, ankle range of motion, complication rate and the incidence of traumatic osteoarthritis (P>0. 05). Conclusions Both EF and ORIF appear to be comparable for treatment of Ruedi-AllgowerⅢPilon fracture. EF is more suitable for patients who have poor conditions of soft tissue while ORIF is more suitable for patients who have good conditions of soft tis-sue.