Pilon骨折ppt课件

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名称来源：1911年首先由法国放射学家 Destotti提出“tibial pilon”一词，他把胫骨 远端干骺端的形状描述为像药剂师的杵棒。 胫骨远端关节面形似天花板,1950年Bonin 称之为“tibial platfond”，因此pilon骨折又
称为platfond 骨折。
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• Definition origin:In 1911, the French radiologist Destotti firstly put forward the word --"tibial pilon“. He described the shape of distal tibia as the pharmacist’s pestle (pilon). The distal tibial articular surface is also looks like ceiling;In 1950,bonin called it “tibial platfond”,so pilon fracture can be called Platfond fracture.
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诊断:根据病史、症状、体征，结合X片、CT等影 像学检查，诊断不难，注意血管、神经等软组织 的损伤，常见胫骨内侧、前侧开放性及潜在开放 性损伤，认真查体，注意勿遗漏身体其他部位的
损伤（脊柱骨折、腓骨上段骨折等）。
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• Diagnosis:According to the medical history,symptoms, signs, combined with X, CT imagings, diagnosis is not difficult, pay attention to vascular, nerve, soft tissue injury, The inside of tibial, anterior open and potential open injury are common, carefully check the body. Pay attention not to miss the other part injury of the body (spinal fractures, upper fibula fracture etc).
Pilon骨折
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定义:pilon骨折是指累及胫 距关节面的胫骨远端骨折。 胫骨Pilon骨折目前尚没有 明确的定义，一般是指胫骨 远端1/3波及胫距关节面的 骨折，胫骨远端关节面严重 粉碎，骨缺损及远端松质骨 压缩。常合并有腓骨下段骨 折（约75%～85% )和严重
软组织损伤。
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• Definition：Pilon fracture refers to distal tibia fractures which involve tibia-astragalus articular surface. Pilon fracture haven’t got clear definition yet, it usually refers to third distal tibia fractures spread from the joint. The distal tibial articular surface always serious shattered, bone defect and remote cancellous bone compression. It usually Associated with the lower part of fibula fractures (about 75% ~ 85%) and serious soft tissue injury.
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（2）手术治疗：
• 手术指征： Ⅱ、Ⅲ型开放性骨折，骨折明 显移位或嵌插、缺损、伴有神经血管损伤、 轴向对线不良、关节面骨折移位大于2mm 者，均需积极行手术治疗。
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• Operation treatment:
• Operation indications: Tpre II, type III open fractures, fracture was obviously displaced or impacted, defect, accompanied by the nerve and vascular injury, the axial malalignment, articular surface fracture displacement is greater than 2mm, these all should be actively treated with surgical operation.
occur most often in the fall, crash arrest, skiing or stumbling before the fall. Axial tibial violence or torsion violence of lower extremity are the main reason for distal tibial articular surface fractures. Two different mechanisms of injury leading to different prognosis of Pilon fracture. The position of ankle joint when it hurts and the type of fracture are closely related.
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• 手术原则：低能量损伤的pilon骨折积极行 切开复位内固定术（ORIF） ；高能量损伤 者，采取有限内固定和外固定结合的治疗
手段。目前主张“生物学”原则：强调细
致的软组织暴露，骨折块的有限剥离，间
接复位，稳定固定后早期活动和晚期负重 等.治疗目的可归纳为“3P”，即保护骨与软 组织活力、进行关节面的解剖复位、提供 满足踝关节早期活动的固定。
fracture, and have severe articular cartilage damage. Treatment is difficult, with many complications, high disability rate, and it is one of the most challenging orthopaedic problems.
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治疗
• （1）非手术治疗：适应于Ⅰ型无移位骨 折、全身情况较差不能耐受手术者、以及 为延期手术做准备的治疗。主要有手法复 位石膏外固定、跟骨牵引等。
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Treatment
• (1) Non operation treatment: Adapted to the type I fractures without displacement, poor general condition which can not tolerate operation, as well as the treatment for the deferred operation. Mainly with manipulative reduction and plaster external fixation, calcaneal traction, closed pinning fixation,etc.
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Ruedi-Allgower分类系统
Ⅰ型:经关节面的胫骨远端骨折，较小的移位; Ⅱ型:明显的关节面移位而粉碎程度较小; Ⅲ型:关节面粉碎移位及粉碎程度较严重。这 种分型临床常用。
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The Ruedi-Allgower classification system:
• Type one:The articular surface fractures of distal tibia, a little displacement;
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损伤机制：胫骨Pilon骨折 最常发生于高处坠落、车 祸骤停、滑雪或绊脚前摔。 胫骨轴向暴力或下肢的扭 转暴力是胫骨远端关节面 骨折的主要原因。两种不 同的损伤机制导致Pilon骨 折，其预后亦不同,受伤时 踝关节的位置与骨折类型
密切相关.
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• Injure mechanism:Tibial Pilon fractures
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骨折分型：骨折分型的目的主要还是在于 如何指导治疗及提示预后情况。1969年 Ruedi和Augower 根据关节面和干骺端的移 位及粉碎程度，将Pilon骨折分为3型，这种
分型的意义在于强调关节面的损伤程度。
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• Fracture classify: The main purpose of fracture classification is to guide treatment and prompt prognosis. In 1969 Ruedi and Augower divided Pilon fracture into 3 types according to the articular surface and metaphyseal displacement and crushing degree,the meaning of this type lies in emphasizing the articular surface damage.
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骨折特征
骨折高度不稳定和关节软骨损 伤严重。治疗难度大，并发症 多，致残率高，是最具挑战性 的骨科难题之一。_内容丰富 点。列出几点.胫骨远端关节面 严重粉碎，骨缺损及远端松质 骨压缩。常合并有腓骨下段骨 折（约75%～85% )和严重软
组织Βιβλιοθήκη Baidu伤
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• Fracture characteristic:It is a highly unstable
• Type two:The obvious articular surface shift and crush lesser degree;
• Type three:Articular surface crushing shift and the degree is serious. This type of commonly used clinical.
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• Operation principle: Low energy damage of Pilon fractures treated with open reduction and internal fixation of positive ( ORIF ); high energy injury, take limited internal fixation and external fixation combined treatment. Currently advocated“ biology” principle: emphasizing meticulous soft tissue exposure, fracture block finite strip, indirect reduction, do early exercise after stable fixation and late weight bearing,etc. Treatment goals can be summarized as “ 3P”, the protection of bone and soft tissue viability (preserve ), anatomical reduction of the articular surface (perform), provide fixations which can satisfy early motion of the ankle joint (provide).