经前外侧改良型切口治疗Pilon骨折

Treatment of Pilon fractures through modified anterolateral incision

目的 ：观察经前外侧改良型切口在Pilon骨折治疗中疗效及并发症。方法 ：2012年3月至2014年12月13例Pilon骨折患者采用前外侧改良型切口治疗,男12例,女1例;年龄28-58岁,平均46.3岁;病程18-47 d。按Rüedi-Allg觟wer分型：Ⅰ型4例,Ⅱ型7例,Ⅲ型2例;其中开放性1例,闭合性12例。患者皆因小腿外伤入院,影像学检查显示Pilon骨折,闭合性Pilon骨折均延期手术,跟骨牵引及消肿处理后行前外侧改良型切口治疗Pilon骨折,按Burwell-Charnley放射学复位标准评定手术复位质量,按照AOFAS Ankle-Hindfoot Scale标准分别在入院时及末次随访中评定踝关节功能。结果：所有患者术后获得随访,时间6-12个月,平均11.5个月。Burwell-Charnley放射学复位评价：解剖复位11例,尚可复位2例。切口Ⅰ期愈合11例,延期愈合2例（1例为双侧Pilon骨折发生延期愈合）。踝关节功能AOFAS评分由术前的（42.15±17.11）分提高到末次随访的（79.15±11.31）分;优3例,良7例,可3例。结论：经前外侧改良型切口治疗Pilon骨折具有骨折愈合率高、切口感染率低、术后并发症少、踝关节功能恢复满意等优点。

Objective：To investigate the effects and complications of improved anterolateral incision in treating Pilon fracture.Methods：From March 2012 to December 2014,13 cases of Pilon fracture were treated by using modified anterolateral incision,including 12 males and 1 female with an average age of 46.3 years old ranging from 28 to 58 years old.Duration was18 to 47 days.According to Ruedi-Allgower type,4 cases belonged to type Ⅰ,7 cases belonged to type Ⅱ,and 2 cases belonged to type Ⅲ.Among them 1 case was open and 12 cases were closed.Patients were admitted to hospital because of the leg trauma,with imaging check showing Pilon fractures.Surgery of closed Pilon fractures were delayed,undergoing improved anterolateral incision treatment of Pilon fractures after calcaneal traction and swelling process.Based on Burwell-Charnley radiological reset criteria,the quality of surgical reduction was assessed.According to the AOFAS Ankle-Hindfoot Scale,ankle function at admission and final follow-up was evaluated respectively.Results：All patients were followed up for 6 to 12 months（averaged 11.5 months）.The quality of surgical reduction of Burwell-Charnley radiological criteria was anatomic reset in 11 cases,fair reset in 2 cases.Among them,11 cases were incision healing,and 2 cases were incision delayed healing（involving 1case of delayed healing for the same patient on both sides of Pilon fracture）.The score of AOFAS ankle-hindfoot was raised from（42.15±17.11） preoperatively to（79.15±11.31） at the final follow-up;the evaluated result was excellent in 3 cases,good in 7 cases and available in 3 cases.Conclusion：Modified anterolateral incision for Pilon fracture has advantages of high rate of fracture healing,low rate of wound infection,fewer complications,ankle function recovery satisfaction and so on.