• 四川大學(xué)華西醫(yī)院骨科（成都，610041）;

Pilon骨折由于創(chuàng)傷能量大，脛骨遠(yuǎn)端軟組織覆蓋少，給臨床治療帶來(lái)困難。手術(shù)治療Pilon骨折的方法包括早期切開(kāi)復(fù)位內(nèi)固定（ORIF）、有限內(nèi)固定結(jié)合外固定、分步延期ORIF和微創(chuàng)技術(shù)。雖然治療手段上不斷修正和更新，但是仍存在并發(fā)癥多、傷殘率高等問(wèn)題?，F(xiàn)就近年P(guān)ilon骨折手術(shù)治療研究作一綜述。

引用本文： 欒富鈞,馬坤龍,李沁,屠重棋,劉雷. Pilon骨折的手術(shù)治療. 華西醫(yī)學(xué), 2012, 27(4): 634-636. doi: 復(fù)制

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(jìn)展[J].中國(guó)骨與關(guān)節(jié)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(fù)壓封閉技術(shù)治療創(chuàng)傷后軟組織缺損[J]. 創(chuàng)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(chuàng)傷軟組織缺損的負(fù)壓封閉治療[J]. 中國(guó)修復(fù)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. 1. 　Rüedi T, Allgower M. Fractures of the lower end of the tibia into the ankle-joint[J]. Injury, 1969, 1: 92.
  2. 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. 3. 　Møller BN, Krebs B. Intra-articular fractures of the distal tibia[J]. Acta Orthop Scand, 1982, 53(6): 991-996.
  4. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 20. 　陳志龍, 蔡林. Pilon骨折的治療進(jìn)展[J].中國(guó)骨與關(guān)節(jié)損傷雜志, 2011, 26(4): 383-384.
  21. 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. 22. 　Syed MA, Panchbhavi VK. Fixation of tibial Pilon fractures with percutaneous cannulated screws[J]. Injury, 2004, 35(3): 284-289.
  23. 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. 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. 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. 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. 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. 28. 　姚元章, 黃顯凱, 麻曉林, 等. 負(fù)壓封閉技術(shù)治療創(chuàng)傷后軟組織缺損[J]. 創(chuàng)傷外科雜志, 2002, 4(1): 9-12.
  29. 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. 30. 　姚元章, 黃顯凱, 麻曉林, 等. 創(chuàng)傷軟組織缺損的負(fù)壓封閉治療[J]. 中國(guó)修復(fù)重建外科雜志, 2002, 16(6): 388-390.
  31. 31. 　Labler L, Oehy K. Vacuum sealing of problem wounds[J]. Swiss Surg, 2002, 8(6): 266-272.