后外侧入路钢板和拉力螺钉内固定治疗踝部皮肤损伤Pilon骨折

Treatment of Pilon fractures complicated with soft tissue injury by plate and lag screw fixation via posterolateral approach

目的:探讨后外侧入路钢板和拉力螺钉内固定治疗踝部皮肤损伤Pilon骨折的临床疗效。方法:选取2013年5月至2016年6月行后外侧入路手术治疗踝部皮肤有损伤的Pilon骨折患者25例,其中男15例,女10例;年龄25~61(39.6±0.2)岁;采用后外侧为主的手术入路使用钢板固定,并辅助使用空心钉三维固定手术治疗。观察并记录踝部伤口及受伤时软组织挫擦伤愈合情况,采用Burwell-Charnley标准和美国足踝外科协会AOFAS踝-足评分系统进行功能评价。结果:25例患者获得随访,时间6~24个月,平均12个月。患者手术伤口及皮肤挤压擦伤均愈合。按照Burwell-Charnley标准,解剖复位22例,不满意2例,差1例。AOFAS踝-足评分为90.2±7.5,结果优20例,良3例,可2例。结论:后外侧入路钢板和拉力螺钉内固定治疗踝部皮肤损伤Pilon骨折可以完全避开前内侧损伤的皮肤及软组织,骨折固定牢固,有效地避免了软组织的进一步损伤坏死。

Objective：To evaluate the clinical effects of plate and lag screw fixation for treatment of Pilon fractures complicated with soft tissue injury via posterolateral approach. Methods：From May 2013 to June 2016,25 patients with Pilon fractures complicated with soft tissue injury underwent open reduction and internal fixation via posterolateral approach. There were15 males and 10 females,aged from 25 to 61 years old with an average of（39.6±0.2） years. Plate and lag screw fixation were used in operation. Healing of soft tissue contusion and abrasions in the ankle wounds and injuries were observed after operation. The Burwell-Charnley standard was applied to assess the quality of fracture reduction and the AOFAS Ankle foot scoring system（total score 100 points） was used to evaluate the clinical effects. Results：All the patients were followed up from 6 to 24 months with an average of 12 months. All operative wounds and soft tissue injuries were healed. According to the Burwell-Charnley standard,22 cases obtained excellent results with anatomic reduction,while 2 cases were dissatisfied,and 1 case poor. The AOFAS ankle foot scores were 90.2±7.5 on average,with 20 cases of excellent results,3 good,2 fair. Conclusion：Plate and lag screw fixation by posterolateral approach in treating Pilon fracture complicated with soft tissue injury shows advantage of avoiding injury to the anteromedial skin and soft tissue,provides forceful fixation without further injury.