分柱显露复位内固定治疗Ruedi-AllgowerⅢ型Pilon骨折

Column exposure and fixation for Ruedi-Allgower typeⅢPilon fractures

目的探讨基于四柱理论分柱显露复位内固定治疗Ruedi-AllgowerⅢ型Pilon骨折的手术技巧与临床疗效。方法回顾性分析自2015-07—2018-09诊治的20例Ruedi-AllgowerⅢ型Pilon骨折,术前制定个体化治疗方案,术中基于四柱理论分柱显露、分柱复位、分柱固定骨折块。结果20例均获得随访,随访时间平均9(8~12)个月。随访期间未出现骨折不愈合、内固定失败、创伤性关节炎。骨折愈合时间10~16周,平均12周。末次随访时所有患者疼痛VAS评分均在3分以下,疼痛VAS评分为1~3分,平均2分。末次随访时踝-后足AOFAS评分为72~93分,平均82分;其中17例AOFAS评分>78分。结论通过制定个体化方案,基于四柱理论采用分柱显露、分柱复位、分柱固定手术治疗Ruedi-AllgowerⅢ型Pilon骨折可取得较好的临床疗效,骨折复位固定满意,骨折愈合相对较快。

Objective To explore the operative technique and clinical effect of the treatment of Ruedi-Allgower typeⅢPilon fracture based on the four column theory.Methods Twenty patients with Ruedi-Allgower typeⅢPilon fractures diagnosed and treated from July 2015 to September 2018 were analyzed retrospectively.The individualized treatment plan was made before the operation.During the operation,the fracture block was exposed by column,reduced by column and fixed by column based on the four column theory.Results Twenty patients were followed up for an average of 9(8-12)months.During the follow-up period,there were no nonunion,failure of internal fixation and traumatic arthritis.The average healing time was 12 weeks(10-16 weeks).At the last follow-up,the VAS score of all patients was less than 3,and the VAS score of pain was 1-3,with an average of 2.At the last follow-up,the AOFAS score of ankle posterior foot was 72-93,with an average of 82 points,of which 17 cases had an AOFAS score over 78 points.Conclusion Based on the four column theory,the treatment of Ruedi Allgower typeⅢPilon fracture by column exposure,column reduction and column fixation can achieve better clinical effect,the reduction and fixation of the fracture is satisfactory,and the fracture healing is relatively fast.