Pilon骨折的三柱理论及其对于手术治疗的指导意义

Three-column theory of Pilon fracture and its guiding significance for surgical treatment

目的探讨根据三柱理论原则治疗Pilon骨折的临床疗效;总结三柱理论对于手术治疗的指导意义。方法回顾性分析2013年1月到2016年2月本院41例按照Pilon骨折三柱理论原则指导下行开放手术治疗并有1年以上完整随访资料的病例资料,其中男32例,女9例;年龄22~84岁,平均45.6岁;均为单侧骨折;高处坠落伤19例,交通伤12例,行走摔扭伤10例。按三柱理论分型为单纯外侧柱骨折7例,单纯内侧柱骨折5例,内侧+外侧柱骨折16例,内、外、后三柱骨折13例。手术切口选择以进入主要力线骨折块的直接入路为主,钢板也按各柱力线方向固定,术后8周采用Burwell-Charnley骨折复位放射学标准评价骨折复位情况,术后6个月采用美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分评价踝关节功能恢复情况。结果 41例病人均获得随访,随访时间为12~26个月(平均15个月)。所有病人均骨折愈合;未出现切口感染、化脓、深静脉血栓形成;2例出现切口周围软组织轻度坏死,1例出现切口脂肪坏死液化等并发症,均换药后痊愈。Burwell-Charnley放射学标准评估:解剖复位30例,复位一般11例,复位差0例;AOFAS踝-后足功能评分为70~91分,平均81.6分。结论 Pilon骨折三柱理论指导手术治疗疗效明显,能使骨折获得更佳的愈合和内固定选择,取得更好的疗效,值得临床推广应用。

Objective To explore the clinical efficacy of Pilon fractures based on the principle of three-column theory, and summarize the guiding significance of three-column theory for surgical treatment. Methods Retrospective analysis of Jan 2013 to Feb 2016, 41 cases of Pilon fractures in accordance with the principle of the three pillars to guide the operation of open surgery and more than 1 year of complete follow-up data of the case data, 32 males and 9 females; age 22 ~ 84 years old, an average of 45.6 years old, are unilateral fractures, 19 cases of high fall injury, traffic injury in 12 cases,10 cases of walking sprain. According to the three-column theory, there were 7 cases of lateral column fractures, 5 cases of internal medial column fractures, 16 cases of medial and lateral column fractures, 13 cases of internal and external posterior column fractures. The surgical incision is selected to enter the main fracture, and the plate is fixed in the direction of the each column. 8 weeks later, Burwell-Charnley fracture reduction Radiotherapy standard for evaluation of fracture reduction, 6 months later, the American Society of Ankle Surgery（American Orthopedic Foot and Ankle Society, AOFAS） ankle-hind foot function score are used for evaluation of ankle joint function recovery. Results Fortyone patients were followed up for 12 to 26 months（mean, 15 months）. All patients were fracture healing, no incision infection, suppurative, deep vein thrombosis, 2 cases of soft tissue around the incision soft tissue necrosis, 1 case of incision fat necrosis liquefaction and other complications, were replaced after healing. Burst-Charnley radiology standard assessment： anatomical reduction in 30 cases, the general reduction of 11 cases, the reduction of 0 cases. AOFAS ankle-hind foot function score of 70 to 91 points, an average of 81.6 points. Conclusion It is effective in Pilon fracture three-column theory to guide the surgical treatment, and can make the fracture better cure and internal fixation options,to achieve better results, worthy of clinical application.