CAJ | 학술논문

目的：探讨采用单侧多功能外固定架结合有限内固定治疗高能量损伤性Pilon骨折的临床效果。方法选择2009年10月至2014年4月大同煤矿集团有限责任公司三医院收治的高能量损伤Pilon骨折12例，骨折按AO/OTA分类，B3型5例，C2型3例，C3型4例；软组织损伤程度按Tscherne分型，闭合性骨折Ⅰ级3例，闭合性骨折Ⅱ级5例，开放性骨折Ⅱ级4例。开放性骨折采用清创，胫骨单侧多功能外固定架结合有限内固定治疗；闭合性骨折采用跟骨牵引，消肿，择期行胫骨单侧多功能外固定架结合有限内固定治疗。结果12例患者均获随访，时间8～21个月，平均随访时间11.3个月。X线片显示：解剖复位5例，一般复位5例，复位差2例；骨折全部愈合，愈合时间6～12个月，平均愈合时间为8.2个月。伤口感染1例，感染率8.3%；出现踝关节行走疼痛、创伤性关节炎5例，发生率41.7%。按美国骨科协会足踝外科分会（AOFAS）评分标准：本组评分56～92分，平均82.5分。结论对于高能量损伤性Pilon骨折，单侧多功能外固定架结合有限内固定的治疗，是一种较好的选择，它减少了皮瓣坏死、感染的发生，也减少了内固定物外露及骨髓炎的发生等并发症，并可有效恢复胫骨长度及力线，促进骨折愈合，减少严重的创伤性关节炎的发生。
목적：탐토채용단측다공능외고정가결합유한내고정치료고능량손상성Pilon골절적림상효과。방법선택2009년10월지2014년4월대동매광집단유한책임공사삼의원수치적고능량손상Pilon골절12례，골절안AO/OTA분류，B3형5례，C2형3례，C3형4례；연조직손상정도안Tscherne분형，폐합성골절Ⅰ급3례，폐합성골절Ⅱ급5례，개방성골절Ⅱ급4례。개방성골절채용청창，경골단측다공능외고정가결합유한내고정치료；폐합성골절채용근골견인，소종，택기행경골단측다공능외고정가결합유한내고정치료。결과12례환자균획수방，시간8～21개월，평균수방시간11.3개월。X선편현시：해부복위5례，일반복위5례，복위차2례；골절전부유합，유합시간6～12개월，평균유합시간위8.2개월。상구감염1례，감염솔8.3%；출현과관절행주동통、창상성관절염5례，발생솔41.7%。안미국골과협회족과외과분회（AOFAS）평분표준：본조평분56～92분，평균82.5분。결론대우고능량손상성Pilon골절，단측다공능외고정가결합유한내고정적치료，시일충교호적선택，타감소료피판배사、감염적발생，야감소료내고정물외로급골수염적발생등병발증，병가유효회복경골장도급력선，촉진골절유합，감소엄중적창상성관절염적발생。
Objective This paper explores the clinical effects of treating high-energy injuring Pilon fracture by unilateral multifunctional external fixation apparatus combined with limited internal fixation. Methods During the period of October 2009 to April 2014, 12 cases of high-energy injuring Pilon fractures were healed which are categorized by AO/OTA in the Third Hospital of Datong Coal Group. Based on this classification, there are 5 cases of Type B3, 3 cases of C2, 4 cases of C3;the extent of injured soft tissues is categorized by Tscherne, including 3 cases of Closed Fracture Level 1 (Tscherne), 5 cases of Closed Fracture Level 2 (Fr.C2), and 4 cases of Open Fracture (Fr.O2). In light of the Open Fracture, the author adopts debridement, as well as unilateral multifunctional external fixation apparatus combined with limited internal fixation on the tibia;in regard of the Closed Fracture, the author uses the calcaneal traction, the detumescence as well as unilateral multifunctional external fixation apparatus combined with limited internal fixation on the tibia on a selected date. Results Random interviews have been completed upon 12 patients during 8 ~ 21 months whose average time span is 11.3 months. The X-ray photos show that there are 5 cases of anatomical reduction, 5 cases of normal reduction and 2 cases of partial reposition;all fractures are recovered during 6~12 months, whose average time span is 8.2 months. 1 case of injury infection takes place, so the infection rate is 8.2%;5 cases of pain during patients' walk in their ankles and injuring arthritis happen, and the incidence rate is 41.7%. According to the AOFAS's rating criteria, the scores of this group range from 56~92 while the average score is 82.5. Conclusion As for high-energy injuring Pilon fracture, the unilateral multifunctional external fixation apparatus combined with limited internal fixation is a good option due to its reduction in skin flap necrosis, the infection, the exposure of internal fixation apparatus as well as the osteomyelitis and other complications. Moreover, this option effectively recovers the length and the line of force of the tibia. This treatment accelerates fracture recovery and decreases the happening of severe injuring arthritis.