改良后内侧入路切开复位内固定治疗后Pilon骨折的疗效分析

An effective analysis of treating posterior Pilon fracture by internal fixation from improved posterior approach incision reduction

目的:评估改良后内侧切口治疗后Pilon骨折的临床疗效。方法:回顾分析2012年5月-2016年5月我科80例后踝骨折患者的临床资料,根据入院时的影像学检查,其中16例诊断为后Pilon骨折,并采用改良后内侧入路切开复位内固定治疗且资料完整。男性6例,女性10例,年龄21~65岁,平均41岁。损伤原因包括坠落伤4例,平地扭伤8例,交通伤4例,其中12例伴外踝骨折,所有均合并关节软骨面塌陷。受伤至手术时间3~11d,平均7d,术后定期随访切口及骨折愈合情况,并采用美国足踝外科学会(AOFAS)踝与后足功能评分系统评价术后疗效。结果:16例均获随访,随访时间5~12个月,平均8个月,所有患者切口均一期愈合,术后X线片提示所有患者均解剖复位(胫骨远端关节面无台阶,踝穴正常)。所有患者均正常骨性愈合,愈合时间8~13周,平均10周。末次随访时AOFAS评分为91~100分,平均95分,其中优12例,良4例,优良率为100%。结论:后Pilon骨折采用改良后内侧切口可完全暴露整个后侧骨折块,软组织损伤小,有利于骨折端的复位及固定。

Objective：To evaluate the clinical efficacy of improved posterior approach incision on posterior Pilon fracture.Methods：The clinical data of 80 cases of posterior malleolus fracture in our department from May 2012 to May 2016 were analyzed retrospectively.16 cases were diagnosed as posterior Pilon fractures and treated by internal fixation from improved posterior approach incision reduction according to the imaging examination at admission.And the data is complete,including 6 men,10 women from 21 to 65 years,and average age is 41 years old.The causes of injury included fall injury in 4 cases,ground sprain in 8 cases,traffic injuries in 4 cases,and with external malleolus fractures in 12 cases,and all of them were associated with articular cartilage surface collapse.The time from injury to surgery was 3 to 11 days,and the average time was 7 days.The incision and healing of fracture were visited periodically after the operation,and the ankle and posterior foot function scoring system of AOFAS was applied to evaluate the postoperative efficacy.Results：16 cases were followed up for 5 to 12 months,and the average time was 8 months,all patients were healed in one stage,and the X-ray of all patients after operation indicated anatomical reduction（no step on the distal tibial joint and normal ankle）.All patients were normal bone healing,the healing time was 8 to 13 weeks,and the average time was 10 weeks.In the last follow-up,the score of AOFAS was 91 to 100 points,and the average score was 95 points.12 cases were healed excellently,4 cases were good,the good rate plus the excellent rate was 100%.Conclusion：The improved posterior approach incision can completely expose the whole posterior Pilon fracture block with less soft tissue injury,and is beneficial to the reduction and fixation of fracture end.