Golubović Zoran, Macukanović-Golubović Lana, Stojiljković Predrag, Jovanović Jovica, Micić Ivan, Stojiljkovioć Danilo, Milić Dragan, Mitković Milorad
Klinicki centar, Ortopedsko-traumatoloska klinika, Bulevar Zorana Dindića br. 48, 18 000 Nis, Srbija.
Vojnosanit Pregl. 2007 May;64(5):307-11. doi: 10.2298/vsp0705307g.
BACKGROUND/AIM: Intraarticular fractures of the tibial plafond (pilon fractures) belong to the group of most severe fractures. They are usually caused by high-energy trauma and frequently associated with a marked soft-tissue damage. Surgical treatment has replaced the traditional nonoperative treatment. The aim of this study was to present the results of the treatment of distal tibial intraarticular fracture by the use of internal fixation, as well as the combination of minimal internal fixation and external fixation.
The study included 47 patients with pilon tibia fractures who went through at the Clinic for Orthopedics and Traumatology, School of Medicine, Nis (1995-2004). Within the analayzed group there were 33 (70.2%) males and 14 (29.8%) females. The patients mean age was 45.8 years. In the first group, which consisted of 22 patients, open reduction and internal fixation of both the tibia and the fibula was performed in the two separate incisions. The second group consisted of 25 patients managed with external fixation by external fixator "Mitković" with limited internal fixation. Besides external fixation, a minimal internal fixation was performed by the use of Kirschner wires and screws. The patients were followed-up inside a 24-months-period. Results. The obtained was a substantially high number of complications after open reduction and internal fixation in the group of patients. There was no difference in a long-term clinical outcome. Postoperative osteitis, as the most severe complication in the management of closed pilon tibia fractures, was not registered in the second group.
Considering the results obtained in this study, it can be concluded that external fixation by the "Mitković" external fixator with the minimal internal fixation is a satisfactory method for the tratment of fractures of the tibial plafond causing less complications than internal fixation.
背景/目的：胫骨平台关节内骨折（pilon骨折）属于最严重的骨折类型。它们通常由高能量创伤引起，且常伴有明显的软组织损伤。手术治疗已取代传统的非手术治疗。本研究的目的是介绍使用内固定以及微创内固定与外固定相结合治疗胫骨远端关节内骨折的结果。
本研究纳入了47例在尼什医学院骨科与创伤科就诊的pilon胫骨骨折患者（1995 - 2004年）。在分析的组中，有33名男性（70.2%）和14名女性（29.8%）。患者的平均年龄为45.8岁。第一组由22名患者组成，在两个单独的切口内对胫骨和腓骨进行切开复位内固定。第二组由25名患者组成，采用“Mitković”外固定器进行外固定并辅以有限的内固定。除了外固定，还使用克氏针和螺钉进行了微创内固定。对患者进行了为期24个月的随访。结果。在切开复位内固定的患者组中出现了大量并发症。长期临床结果无差异。术后骨炎是闭合性pilon胫骨骨折治疗中最严重的并发症，第二组未出现。
考虑到本研究获得的结果，可以得出结论，使用“Mitković”外固定器进行外固定并辅以微创内固定是治疗胫骨平台骨折的一种令人满意的方法，其并发症比内固定少。
