后外侧入路治疗后方Pilon骨折

Surgical treatment of posterior pilon fracture by the posterolateral approach

目的探讨后外侧入路切开复位内固定(ORIF)治疗后方Pilon骨折的疗效及并发症。方法 2009年8月至2010年3月期间,使用后外侧入路治疗14例后方Pilon骨折,均涉及胫骨远端关节面超过20%,其中男11例,女3例,平均年龄41·3岁。结果平均随访14·5个月。12例骨折得到解剖复位(86%);没有出现伤口感染及神经血管损伤;没有发现因屈踇长肌挛缩至屈踇畸形;1例患者因腓骨后方钢板出现腓骨肌腱刺激症状。根据Philips评分系统,优10例,良2例,优良率为92·8%。结论通过后外侧入路可以使后方Pilon骨折得到良好的显露以及直接复位,操作简单、有效。

Objective To review the results and complications of open reduction and internal fixation （ORIF） of posterior pilon fracture using the posterolateral approach. Methods Fourteen consecutive posterior pilon fracture cases were surgically treated by the posterolateral approach and followed up with an average time of 14.5 （range, 12 - 18） months. The average age was 41.3 （ ranging from 21 to 76） years. Results There was no wound complication or neurovascular injury, and one patient with peroneal tendon irritation needed early implant removal. 12 cases of fracture were anatomical reduction （86%）. 10 cases achieved good results according to Philips system. Conclusions For posterior pilon fracture, posterolateral approach will provide sufficient visualization for reduction and fixation, and is a useful option to treat this difficult fracture pattern.