后Pilon骨折诊疗新进展

NEW PROGRESS IN DIAGNOSIS AND TREATMENT OF POSTERIOR PILON FRACTURES

后Pilon骨折是累及后踝和内踝的冠状面骨折,具有独特的解剖学基础和损伤机制。在平时的诊疗工作中,后Pilon骨折容易与传统的三踝骨折混淆。目前其影像学诊断及临床分型主要依靠CT断层扫描及三维成像。该病保守治疗往往预后较差,但是如果诊疗计划不完整,手术治疗将会发生较多的远期并发症,因此需要在术前管理、手术时机、手术体位、手术入路、固定顺序及固定方式等方面进行全面选择。本文对后Pilon骨折的受伤机制、诊断分型、治疗方式、并发症及预后等进行综述。

A posterior pilon fracture is a type of coronal fracture involving the posterior and medial malleoli,with a unique anatomical basis and injury mechanism.In the usual diagnosis and treatment work,posterior pilon fractures are easily confu-sed with the conventional trimalleolar fractures.At present,its imaging diagnosis and clinical classification mainly rely on computed tomography and three-dimensional imaging.The conservative treatment often has a poor prognosis.However,the surgical treatment also leads to many long-term complications if the diagnosis and treatment plan is not comprehensive.Therefore,it is necessary to make a comprehensive decision on the preoperative management,timing of surgery,operative position,surgical approach,fixation sequence,and fixation mode.This article reviews the injury mechanism,diagnosis and classification,treatment modalities,complications,and prognosis of posterior pilon fractures.