高能量Pilon骨折治疗策略

摘要

胫骨Pilon骨折属于关节内骨折且软组织损伤重,因此其处理对骨科医生仍是挑战.本讲座旨在通过复习文献提出一种高能量Pilon骨折的治疗策略.文中简要复习了Pilon骨折的基本知识和分类,对几个有争议的问题进行讨论,并根据研究进展和笔者临床经验提出高能量Pilon骨折的治疗方案,建议采用分期治疗骨折:Ⅰ期采用超关节外支架临时固定,待软组织条件改善后,Ⅱ期行确定性治疗.然而,目前尚无胫骨高能量Pilon骨折的最佳治疗方案.%Management and treatment of pilon fracture provide a significant challenge to orthopedic sur-geons,as they are typically intra-articular and associated with extensive soft tissue damage.The purpose of this lec-ture was to present a treatment strategy.First,we briefly reviewed basic knowledge in pilon fracture,as well as clas-sification of pilon fractures.Then,we discussed some controversies in the management of high-energy pilon fracture. Finally,we proposed a treatment algorithm according to the literatures and authors' collective clinical experience. The use of a staged treatment protocol was recommended:initial spanning external fixation, definitive fixation followed by good recovery of soft tissues.However,the optimum management for tibial pilon fractures is yet undetermined.