Pilon骨折的手術治療_West China Medical Journal

Authors：

欒富鈞 , 馬坤龍 , 李沁 , 屠重棋 ,  劉雷

Corresponding?author：

劉雷, Email: grun198410@163.com

Keywords：

Pilon骨折; 手術治療; 并發癥

Video：

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Pilon骨折由于創傷能量大，脛骨遠端軟組織覆蓋少，給臨床治療帶來困難。手術治療Pilon骨折的方法包括早期切開復位內固定（ORIF）、有限內固定結合外固定、分步延期ORIF和微創技術。雖然治療手段上不斷修正和更新，但是仍存在并發癥多、傷殘率高等問題。現就近年Pilon骨折手術治療研究作一綜述。

Citation： 欒富鈞,馬坤龍,李沁,屠重棋,劉雷. Pilon骨折的手術治療. West China Medical Journal, 2012, 27(4): 634-636. doi: Copy

1.	Rüedi T, Allgower M. Fractures of the lower end of the tibia into the ankle-joint[J]. Injury, 1969, 1: 92.
2.	McFerran MA, Smith SW, Boulas HJ, et al. Complications encountered in the treatment of pilon fractures[J]. J Orthop Trauma, 1992, 6(2): 195-200.
3.	Møller BN, Krebs B. Intra-articular fractures of the distal tibia[J]. Acta Orthop Scand, 1982, 53(6): 991-996.
4.	Teeny SM, Wiss DA. Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications[J]. Clin Orthop Relat Res, 1993(292): 108-117.
5.	Conroy J, Agrwal M, Giannoudis PV , et al. Early internal fixation and soft tissue cover of severe open tibial Pilon fractures [J]. Int Orthop, 2003, 27(6): 343-347.
6.	Koulouvaris P, Stafylas K, Mitsionis G, et al. Long-term results various therapy concepts in severe pilon fr actures[J]. Arch Onhop Trauma Surg, 2007, 127(5): 313-320.
7.	Ronga M, Longo UG, Maffulli N.Minimally invasive locked plating of distal tibia fractures is safe and effective[J]. Clin Orthop Relat Res, 2010, 468(4): 975-982.
8.	Bone L, Stegemann P, McNamara K, et al. External fixation of severely comminuted and open tibial pilon fractures[J]. Clin Orthop Relat Res, 1993(292): 101-107.
9.	Pugh KJ, Wolinsky PR, McAndrew MP, et al. Tibial pilonfractures: a comparison of treatment methods[J]. J Trauma, 1999, 47(5): 937-941.
10.	Anglen JO. Early outcome of hybrid external fixation for fracture of the distal tibia[J]. J Orthop Trauma, 1999, 13(2): 92-97.
11.	Golubovi? Z, Macukanovi?-Golubovi? L, Stojiljkovi? P, et al. External fixation combined with limited internal fixation in the treatment of Pilon tibia fractures[J]. Vojnosanit Pregl, 2007, 64(5): 307-311.
12.	Watson JT, Moed BR, Karges DE, et al. Pilon fractures: treatment based on severity of soft tissue injury[J]. Clin Orthop Relat Res, 2000(375): 78-90.
13.	Polak AN, McCarthy ML, Bess RS, et al. Outcomes after treatment of high-energy tibial plafond fractures[J]. J Bone Joint Surg(Am), 2003, 85(10): 1893-1900.
14.	Helfet DL, Koval K, Pappas J, et al. Intraarticular ‘‘pilon’’fracture of the tibia[J]. Clin Orthop Relat Res, 1994(298): 221-228.
15.	Blauth M, Bastian L, Krettek C, et al. Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques[J]. J Orthop Trauma, 2001, 15(3): 153-160.
16.	Queitsch C, Kienast B, Fuchs S, et al. Fracture of the distal lower limb: two-s tage surgical treatment with external fixator and locked-screw plate [J]. Zentralbl Chir, 2006, 131(3): 194-199.
17.	Sirkin M, Sanders R, DiPasquale T, et al. A staged protocol for soft tissue management in the treatment of complex pilon fractures[J]. J Orthop Trauma, 1999, 13(2): 78-84.
18.	Patterson MJ, Cole JD. Two-staged delayed open reduction and internal fixation of severe pilon fractures[J]. J Orthop Trauma, 1999, 13(2): 85-91.
19.	Grose A, Gaidner MJ, Hettrich C, et al. Open reduction and internal fixation of tibial Pilon fractures using a lateral approach[J]. J Orthop Trauma, 2007, 21(8): 530-537.
20.	陳志龍, 蔡林. Pilon骨折的治療進展[J].中國骨與關節損傷雜志, 2011, 26(4): 383-384.
21.	Borens O, Kloen P, Richmond J, et al. Minimally invasive treatment of pilon fractures with a low profile plate: Preliminary results in 17 cases[J]. Arch Orthop Trauma Surg, 2006, 129(5): 649-659.
22.	Syed MA, Panchbhavi VK. Fixation of tibial Pilon fractures with percutaneous cannulated screws[J]. Injury, 2004, 35(3): 284-289.
23.	Bahari S, Lenehan B, Khan H, et al. Minimally invasive percutaneous plate fixation of distal tibia fractures[J]. Acta Orthop Belg, 2007, 73(5): 635-640.
24.	Gupta RK, Rohilla RK, Sangwan K, et al. Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients[J]. Int Orthop, 2010, 34(8): 1285-1290.
25.	Hazarika S, Chakravatthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia: results in 20 patients[J]. Injury, 2006, 37(9): 877-887.
26.	Hasenboehler E, Rikli D, Babst R. Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: a retrospective study of 32 patients [J]. Injury, 2007, 38(3): 365-370.
27.	Cheng W, Li Y, Manyi W. Comparison study of two surgical options for distal tibia fracture-minimally invasive plate osteosynthesis vs. open reduction and internal fixation[J]. Int Orthop, 2010, 35(5): 737-742.
28.	姚元章, 黃顯凱, 麻曉林, 等. 負壓封閉技術治療創傷后軟組織缺損[J]. 創傷外科雜志, 2002, 4(1): 9-12.
29.	Polykandriotis E, KneserU, Kopp J, et al. Modified gloving technique for vacuum therapy in the hand[J]. Zentralbl Chir, 2006, 131(Suppl 1): S36-39.
30.	姚元章, 黃顯凱, 麻曉林, 等. 創傷軟組織缺損的負壓封閉治療[J]. 中國修復重建外科雜志, 2002, 16(6): 388-390.
31.	Labler L, Oehy K. Vacuum sealing of problem wounds[J]. Swiss Surg, 2002, 8(6): 266-272.

1. 　Rüedi T, Allgower M. Fractures of the lower end of the tibia into the ankle-joint[J]. Injury, 1969, 1: 92.
2. 　McFerran MA, Smith SW, Boulas HJ, et al. Complications encountered in the treatment of pilon fractures[J]. J Orthop Trauma, 1992, 6(2): 195-200.
3. 　Møller BN, Krebs B. Intra-articular fractures of the distal tibia[J]. Acta Orthop Scand, 1982, 53(6): 991-996.
4. 　Teeny SM, Wiss DA. Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications[J]. Clin Orthop Relat Res, 1993(292): 108-117.
5. 　Conroy J, Agrwal M, Giannoudis PV , et al. Early internal fixation and soft tissue cover of severe open tibial Pilon fractures [J]. Int Orthop, 2003, 27(6): 343-347.
6. 　Koulouvaris P, Stafylas K, Mitsionis G, et al. Long-term results various therapy concepts in severe pilon fr actures[J]. Arch Onhop Trauma Surg, 2007, 127(5): 313-320.
7. 　Ronga M, Longo UG, Maffulli N.Minimally invasive locked plating of distal tibia fractures is safe and effective[J]. Clin Orthop Relat Res, 2010, 468(4): 975-982.
8. 　Bone L, Stegemann P, McNamara K, et al. External fixation of severely comminuted and open tibial pilon fractures[J]. Clin Orthop Relat Res, 1993(292): 101-107.
9. 　Pugh KJ, Wolinsky PR, McAndrew MP, et al. Tibial pilonfractures: a comparison of treatment methods[J]. J Trauma, 1999, 47(5): 937-941.
10. 　Anglen JO. Early outcome of hybrid external fixation for fracture of the distal tibia[J]. J Orthop Trauma, 1999, 13(2): 92-97.
11. 　Golubovi? Z, Macukanovi?-Golubovi? L, Stojiljkovi? P, et al. External fixation combined with limited internal fixation in the treatment of Pilon tibia fractures[J]. Vojnosanit Pregl, 2007, 64(5): 307-311.
12. 　Watson JT, Moed BR, Karges DE, et al. Pilon fractures: treatment based on severity of soft tissue injury[J]. Clin Orthop Relat Res, 2000(375): 78-90.
13. 　Polak AN, McCarthy ML, Bess RS, et al. Outcomes after treatment of high-energy tibial plafond fractures[J]. J Bone Joint Surg(Am), 2003, 85(10): 1893-1900.
14. 　Helfet DL, Koval K, Pappas J, et al. Intraarticular ‘‘pilon’’fracture of the tibia[J]. Clin Orthop Relat Res, 1994(298): 221-228.
15. 　Blauth M, Bastian L, Krettek C, et al. Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques[J]. J Orthop Trauma, 2001, 15(3): 153-160.
16. 　Queitsch C, Kienast B, Fuchs S, et al. Fracture of the distal lower limb: two-s tage surgical treatment with external fixator and locked-screw plate [J]. Zentralbl Chir, 2006, 131(3): 194-199.
17. 　Sirkin M, Sanders R, DiPasquale T, et al. A staged protocol for soft tissue management in the treatment of complex pilon fractures[J]. J Orthop Trauma, 1999, 13(2): 78-84.
18. 　Patterson MJ, Cole JD. Two-staged delayed open reduction and internal fixation of severe pilon fractures[J]. J Orthop Trauma, 1999, 13(2): 85-91.
19. 　Grose A, Gaidner MJ, Hettrich C, et al. Open reduction and internal fixation of tibial Pilon fractures using a lateral approach[J]. J Orthop Trauma, 2007, 21(8): 530-537.
20. 　陳志龍, 蔡林. Pilon骨折的治療進展[J].中國骨與關節損傷雜志, 2011, 26(4): 383-384.
21. 　Borens O, Kloen P, Richmond J, et al. Minimally invasive treatment of pilon fractures with a low profile plate: Preliminary results in 17 cases[J]. Arch Orthop Trauma Surg, 2006, 129(5): 649-659.
22. 　Syed MA, Panchbhavi VK. Fixation of tibial Pilon fractures with percutaneous cannulated screws[J]. Injury, 2004, 35(3): 284-289.
23. 　Bahari S, Lenehan B, Khan H, et al. Minimally invasive percutaneous plate fixation of distal tibia fractures[J]. Acta Orthop Belg, 2007, 73(5): 635-640.
24. 　Gupta RK, Rohilla RK, Sangwan K, et al. Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients[J]. Int Orthop, 2010, 34(8): 1285-1290.
25. 　Hazarika S, Chakravatthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia: results in 20 patients[J]. Injury, 2006, 37(9): 877-887.
26. 　Hasenboehler E, Rikli D, Babst R. Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: a retrospective study of 32 patients [J]. Injury, 2007, 38(3): 365-370.
27. 　Cheng W, Li Y, Manyi W. Comparison study of two surgical options for distal tibia fracture-minimally invasive plate osteosynthesis vs. open reduction and internal fixation[J]. Int Orthop, 2010, 35(5): 737-742.
28. 　姚元章, 黃顯凱, 麻曉林, 等. 負壓封閉技術治療創傷后軟組織缺損[J]. 創傷外科雜志, 2002, 4(1): 9-12.
29. 　Polykandriotis E, KneserU, Kopp J, et al. Modified gloving technique for vacuum therapy in the hand[J]. Zentralbl Chir, 2006, 131(Suppl 1): S36-39.
30. 　姚元章, 黃顯凱, 麻曉林, 等. 創傷軟組織缺損的負壓封閉治療[J]. 中國修復重建外科雜志, 2002, 16(6): 388-390.
31. 　Labler L, Oehy K. Vacuum sealing of problem wounds[J]. Swiss Surg, 2002, 8(6): 266-272.

West China Medical Journal

Pilon骨折的手術治療

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