双入路手术方法治疗严重Pilon骨折的近期疗效

Short-term efficacy of double operative approaches for severe Pilon fractures

目的探讨严重Pilon骨折的手术显露及复位固定。方法采取经踝前内侧人路＋经腓骨骨折或腓骨截骨入路显露胫距关节的方法，直视下复位，先固定胫骨再固定腓骨，共处理Rtiedi—Allg（iwerⅢ型或AO／OTA的c3型严重Pilon骨折11例。结果所有骨折复位效果均较满意，其中9例创口Ⅰ期愈合，2例Ⅱ期愈合，无骨质感染。骨折及截骨处均获得愈合。结论通过踝内侧及经腓骨显露胫骨内外侧的双入路手术方法能完整显露胫距关节，有利于移位骨块的复位与固定，对于严重Pilon骨折术后能获得一个良好的近期复位固定效果。

Objective To investigate surgical exposure, reduction and fixation of the severe Pi- lon fractures. Methods A total of 11 patients with severe Pilon fractures （ Rtiedi-Allgwer type II1 or AO/OT type C3 ） were managed by anteriormedial malleolar approach in combination with transfibular fracture or fibular osteotomy approach to reveal the tibiotalar joint. Reduction was performed under direct vision and then the tibia was fixed followed by fibula fixation. Results All patients obtained satisfacto- ry bone reduction including nine patients with [ stage wound healing and two with 1I stage wound heal- ing. No sclerotin infection occurred. The fractures as well as the osteotomy sites were healed. Conclu- sions The double operative approaches can completely expose the tibiotalar joint, favor the reduction and fixation of the displaced bone fragments and attain satisfactory short-term reduction and fixation effects in the treatment of severe Pilon fractures.