后Pilon骨折的诊断和治疗新进展

New progress in diagnosis and treatment of posterior pilon fracture

后Pilon骨折是一种挑战性的损伤。关于它的确定性手术治疗,具有多种选择,但没有I级证据表明是最佳治疗。骨折解剖复位、关节的复位、后柱重建、恢复正确的肢体力线轴,尽量减少软组织的损伤,是治疗后Pilon骨折的关键因素。即使实现了这些目标,也不能保证会减缓创伤后关节炎的进展。在伴有严重软组织损伤的后Pilon骨折中,分期治疗通常被认为是治疗的最佳方法,并被认为是一种局部的"损害控制"策略。CT扫描图像的轴向切割是确定主要骨折线位置、骨折模式(矢状或冠状)和碎片数目的必要条件。所有这些信息对于术前的计划,切口的选择和关节面的复位都是至关重要的。没有单一的固定方法适合所有的后Pilon骨折。最终的决策主要取决于骨折的类型、软组织的状况、患者的基本情况和外科技术。

Posterior Pilon fracture is a challenging injury. There are many options for its deterministic surgical treatment,but there is no class I evidence that it is the best treatment. Anatomical reduction of fracture, reduction of joint,reconstruction of posterior column,recovery of correct force axis of limbs and minimization of soft tissue injury are the key factors for Pilon fracture after treatment. Even if these goals are achieved,there is no guarantee that the progression of post-traumatic arthritis will be slowed. In post-Pilon fractures with severe soft tissue injuries,staging therapy is generally considered to be the best treatment and is considered a local " damage control" strategy. Axial cutting of CT scan images is used to determine the location of the main fracture lines,and necessary conditions for fracture patterns ( sagittal or coronal) and the number of fragments. All this information is essential for preoperative planning,incision selection,and articular surface reduction. There is no single fixation suitable for all posterior Pilon fractures. The final decision depends mainly on the type of fracture,soft tissue condition,patients' basic condition,and surgical techniques.