经前正中切口结合L型解剖锁定板治疗Rüedi-Allgower Ⅱ、Ⅲ型pilon骨折

Treatment of pilon fractures of Ruedi-Allg（o）wer types Ⅱ and Ⅲ via anterior intermediate incision with L-shaped anatomical locking compression plate

目的 探讨经前正中切口结合胫骨干骺端L型解剖锁定板治疗Ruedi-Allg（o）werⅡ、Ⅲ型pilon骨折的疗效.方法 对2011年1月至2013年6月收治的18例pilon骨折患者资料进行回顾性分析,男13例,女5例;年龄23 ～76岁,平均48.1岁;骨折按照Ruedi-Allg（o）wer分型：Ⅱ型8例,Ⅲ型10例;闭合性骨折12例,开放性骨折6例,合并踝关节脱位4例.开放性骨折一期进行腓骨复位和内固定结合内侧胫骨跨踝关节外固定支架固定,二期（平均10d后）拆除外固定支架后再进行胫骨切开复位钢板内固定.闭合性骨折均延期手术,先采用后外侧切口进行腓骨复位和内固定,接着采用前正中切口进行胫骨chaput结节的复位和固定.中柱关节面以及内侧柱骨块参照chaput结节进行复位,以胫骨干骺端L型解剖锁定板固定.结果 所有患者术后获6 ～ 24个月（平均12个月）随访.按Burwell-Charnley放射学评价标准评定复位质量：解剖复位14例,复位可4例;骨折均获愈合,平均时间为14周;踝关节功能按Mazur评分标准评定：优10例,良6例,可2例.结论 延期经前正中切口结合胫骨干骺端L型解剖锁定板治疗Ruedi-Allg（o）werⅡ、Ⅲ型pilon骨折具有固定牢靠、愈合率高、切口并发症少、功能恢复满意等优点.恢复踝关节外侧柱的稳定性在胫骨pilon骨折治疗中极其重要.

Objective To observe the therapeutic results of treating pilon fractures of Riedi-Allg（o）wer types Ⅱ and Ⅲ via the anterior intermediate incision with an L-shaped anatomical locking compression plate （LCP）.Methods From January 2011 to June 2013,18 patients with pilon fractures of Ruedi-Allg（o）wer types Ⅱ and Ⅲ received surgery in our department.They were 13 males and 5 females,aged from 23 to 76 years （average,48.1 years）.Eight cases were type Ⅱ and 10 cases type Ⅲ; 12 cases were closed and 6 cases open; 4 cases had concomitant ankle dislocation.For open fractures,fibular reduction and internal fixation plus a medial spanning external fixator was performed at the first stage,followed by tibial open reduction and internal plating after removal of the external fixator （10 days on average） at the second stage.For closed injury,we adopted staged therapy.The patients underwent fibular reduction and internal fixation through the posterolateral incision,followed by reduction and fixation of the chaput tubercle through the anterior intermediate incision.The articular surface of the middle ankle column and bone fragments of the medial column were reduced the way as for the chaput tubercle,and fixated with an L-shaped anatomical LCP at the tibial metaphysis.Results All patients were followed up for an average of 12 months （from 6 to 24 months）.According to the Burwell-Charnley radiological criteria,anatomical reduction was achieved in 14 cases,and fair reduction in 4.All the fractures healed after a mean period of 14 weeks.According to the Mazur clinical criteria,ankle functions were rated as excellent in 10 cases,good in 6,and fair in 2.Conclusions In staged treatment of tibial pilon fractures of Ruedi-Allg（o）wer types Ⅱ and Ⅲ,reduction and fixation with anatomical L-shaped anatomical LCP via the anterior intermediate incision can result in stable fixation,a high rate of bone union,limited incision-related complications and satisfactory functional recovery.Restoring stability of the ankle lateral column is extremely important in the treatment of tibial pilon fractures.