后外侧作为基础入路内固定治疗合并外踝骨折后Pilon骨折的效果分析

Clinical outcomes of distal tibia posterior locking plate internal fixation for posterior Pilon fractures with lateral malleolus fracture through a combined posterolateral approach

目的探讨以后外侧入路为基础入路结合锁定接骨板治疗合并外踝骨折的后Pilon骨折的手术方法及疗效。方法回顾性分析2014年1月至2018年1月本院收治的59例合并外踝骨折的后Pilon骨折患者临床资料,男性33例,女性26例;年龄21~69岁,平均46.8岁。扭伤29例,高处坠落伤21例,车祸伤9例。左侧31例,右侧28例。俞光荣分型:Ⅰ型19例,Ⅱ型24例,Ⅲ型16例。所有患者采用以后外侧入路为基础入路结合锁定接骨板治疗,记录患者术后并发症、骨愈合及复位情况,采用美国足踝外科协会踝关节与后足功能评分对踝关节功能进行评估。结果 59例患者平均随访18(12~30)个月。Burwell-Charnley标准评定骨折复位情况:解剖复位46例,良好9例,优良率93.2%;骨折平均愈合时间为11周(9~15.5周);休息、运动及负重状态VAS评分均值分别为0.54、0.77、1.31;踝关节功能AOFAS评分结果:优45例,良11例,可3例,优良率94.9%;无感染、内固定失效、不愈合、畸形愈合等并发症。结论以后外侧入路为基础入路结合锁定接骨板治疗合并外踝骨折的后Pilon骨折,入路清晰,操作灵活,固定可靠,利于早期功能锻炼,术后并发症少,临床疗效满意。

Objective To explore the surgical method and the efficacy of posterolateral approach combined with locking plate for treatment of posterior Pilon fracture with lateral malleolus fracture.Methods We retrospectively analyzed the clinical data of 59 patients with posterior Pilon fracture complicated by lateral malleolus fracture treated in our hospital from January,2014 to January,2018,including 33 male and 26 female patients aged 21-69 years(mean 46.8 years).Among these cases,the fractures resulted from sprains in 29 cases,falling in 21 cases and traffic accidents in 9 cases;the fractures occurred on the left side in 31 cases and on the right in 28 cases.According to YU Guangrong’s classification,19 patients had typeⅠ,24 had typeⅡand 16 had typeⅢfractures.All the patients underwent distal tibia posterior locking plate internal fixation through a combined posterolateral approach,and the postoperative complications,bone healing time and fracture reduction were recorded;the ankle function was assessed based on the American Orthopaedic Foot and Ankle Society(AOFAS)score.Results The patients were followed up for 12 to 30 months(mean 18 months)after the operation.According to the Burwell-Charnley’s criteria,anatomical reduction was achieved in 46 cases and good reduction in 9 cases,with an excellent and good reduction rate of 93.2%.The mean healing time of the fracture was 11 weeks(9-15.5 weeks).The mean VAS scores at rest,in motion and in weight bearing were 0.54,0.77 and 1.31,respectively.The ankle function,as evaluated according to AOFAS scores,was excellent in 45 cases,good in 11 cases,and acceptable in 3 cases,with an excellent and good function rate of 94.9%.No such complications as infection,failure of internal fixation,nonunion or malunion occurred during the follow-up.Conclusion The posterolateral approach combined with the locking plate,which has a clear surgical approach to allow flexible operation and reliable fixation,can achieve satisfactory clinical effect for treatment of posterior Pilon fracture with lateral malleolus fracture and promotes early functional recovery.