目的 探讨超踝外固定支架配合简易内固定治疗Ⅲ型Pilon骨折的临床疗效。方法 分析26例Ⅲ型Pilon骨折患者资料,手术采用超踝外固定支架牵引复位配合克氏针简易内固定的治疗。结果 随访10~18个月,平均12个月;骨折愈合时间18~25周,平均 20周;术后踝关节功能按Mazur评分标准:优13例,良10例,可3例,优良率为88%;除1例出现针道感染外,其余伤口愈合良好,无骨折不愈合及延迟愈合发生,手术过程无血管、神经副损伤。结论 采用超踝外固定支架配合简易内固定的方法,可最大限度地减少手术创伤,术后可带架早期活动踝关节,减少并发症的发生。

Objective To study the efficacy of spanning external fixation plus simple internal fixation for Type Ⅲ Pilon fracture. Methods This study enrolled 26 patients with type Ⅲ Pilon fracture. They underwent spanning external fixation plus simple internal fixation with Kirschner wire. Results All patients were followed up for 10-18 months (average 12 months), the healing time was 18 to 25 weeks (average 20 weeks), 13 cases had excellent results, 10 cases good and 3 cases fair according to Mazur’s criteria. The excellent and good rate was 88%. The wounds healed well except that 2 cases developed pin-related infection, There were no delay fracture healing and nonunion, nor vessel and accessory nerve injury. Conclusions Type Ⅲ Pilon fracture is difficult to deal with because of the poor skin condition and the severe comminuted fracture. It cannot be fixed by plate and screws. Spanning external fixation plus simple internal fixation is the best way for type Ⅲ Pilon fracture. It is relatively simple, easy to learn and can minimize the operative trauma. It has advantages of early movement and less complications.