제한 절개를 통한 관혈적 정복 및 내고정술을 이용한 경골 Pilon 골절의 치료

Limited Open Reduction and Internal Fixation of the Tibial Pilon Fractures

저자들은 1993년 9월부터 1996년 5월까지 본원 정형외과에 입원하여 Pilon 골절로 치료받고 1년 이상 추시 가능하였던 19례(18명)를 대상으로 다음과 같은 결론을 얻었다. 1. Ovadia와 Beals의 분류상 제1형이 2례, 제2형이 3례, 제3형이 10례, 제4형이 1례, 제5형이 3례였고, 제3형이 53%로 가장 많았으며, 교통사고와 추락손상 등 고에너지 손상에 의한 골절이 16례로 전체의 약 84%를 차지하였다. 2. 손상의 정도가 비교적 적은 제1형과 제2형에서는 모두 양호 이상의 임상결과를 나타내었으며, 제4형과 5형에서는 손상의 정도가 심하고 이로인한 정확한 정복의 어려움으로 인해 보통 이하의 성적을 나타내었다. 3. 합병증은 외상후 관절염이 6례로 가장 많았으며 손상정도가 심한 3형 이상에서 정확한 정복이 이루어지지 않은 경우에 발생하였으며, 방사선학적 평가가 보통이하였던 제3형 3례에서 부정 유합이 발생하였으나 임상결과와의 연관성은 없었다. 4. 저자들은 제한된 관혈적 정복 및 내고정술로 연부조직의 합병증을 현격히 줄일 수 있었으며, 손상의 정도가 적고 정확한 정복이 가능한 경우, Pilon 골절의 좋은 치료 술식의 하나라고 사료된다.

The tibial Pilon fracture, which is defined as a comminuted intraarticular fracture of the distal tibia, is difficult to manage because high axial compression and rotational forces to the ankle joint result in impaction, severe comminution, metaphyseal disruption and soft tissue damage. There are variable methods of treatment such as manipulation and cast, calcaneal traction and cast, external fixation, pin and plaster, limited open reduction and external fixation, and open reduction and rigid internal fixation. Though most of authors reported better result after a surgical treatment. than that of conservative treatment, many complications such as posttraumatic arthritis and soft tissue problem still remain troublesome. We have reviewed 19 cases of the tibial Pilon fractures in 18 patients which were treated with limited open reduction and internal fixation from September 1993 to May 1996. The results were as follows: 1. The fractures were classified into five types according to the system of Ovadia and Beals, and the most frequent type was type 3 (53%). The most common cause of injury was traffic accident (47%). 2. All of the cases of type 1 and 2, in which the injury of the ankle joint was less severe, revealed good or excellent clinical results. But in type 4 and 5, because the injury is much severe and accurate reduction is difficult, the clinical results were unsatisfaetory. 3. The most frequent complication was posttraumatic osteoarthritis, and which developed in second frequent complication, was developed m the three cases of type 3 in which the radiographic results were less than fair, but there were no correlation with the clinical results. 4. We could markedly reduce the complications related to the soft tissue problem of Pilon fracture by treatment with limited open reduction and internal fixation, and consider that this is a good method of treatment of Pilon fracture when the injury is less severe and accurate reduction is possible.