后pilon骨折的诊断与治疗进展

Updated developments in diagnosis and treatment of posterior pilon fracture

后pilon骨折是一类特殊、独立的踝关节骨折，文献报道其发病率约占全部pilon骨折的5.6%，全部三踝骨折的6.4%。特点为后踝骨折线沿胫骨远端冠状面延伸至内踝后丘，多合并踝关节后脱位、软骨损伤和外踝骨折。由于损伤机制和治疗原则不同于传统踝关节骨折和经典pilon骨折，越来越多的文献支持将其从三踝骨折和pilon骨折中独立，但由于认识时间短、发病率低、骨折形态差异大等原因，后pilon骨折的损伤机制、骨折分型和手术入路仍是骨科界争论的焦点问题。后pilon骨折多为高能量垂直暴力与低能量扭转剪力共同作用导致后踝、外踝甚至内踝的骨折。理想的骨折分类提示损伤机制、损伤程度、指导治疗和判断预后，目前尚无一种分类方法能够兼顾骨折损伤机制，描述后踝、内踝骨折形态，指导手术和判断预后，因此手术入路和策略也见仁见智。对后pilon骨折的损伤机制、初期评估软组织损伤和骨折、基于CT横断面的骨折形态分型、手术入路和固定方式等进行综述，以期提高后pilon骨折的认识，减少围手术期的并发症。

Posterior pilon fracture is a special and unique type of ankle fracture, and its injury mechanism and treatment principles are different from those of the trimalleolar fracture in the Lauge-Hansen classification, and also different from those described for the classic pilon fracture. The fractures have a low incidence and generally poor prognosis. The prevalence of posterior pilon fractures is 6.4% of all trimalleolar fractures, and 5.6% of all pilon fractures based on computed tomography images. The pathological features of posterior pilon fractures are different from those of the traditional ankle fracture and the classic pilon frac- ture, and it is very important to differentiate a posterior pilon fracture from the others. Because of the low incidence and high variation in fracture morphology, there is controversy over the practicable classification of posterior pilon fractures based on clinical fea- tures, such as injury mechanism, fracture classification and surgical approach. An ideal fracture classification system can reveal the injury mechanism and severity, guide the treatment, and predict prognosis. At present, no classification method is based on the injury mechanism, and none can summarize fracture morphology and guide treatment. The purpose of this study was to review the injury mechanism, clinical characteristics, classifications, treatments, and outcomes of posterior pilon fractures, to promote sur- geons＂ understanding of posterior pilon fracture and reduce perioperative complication.