经腓骨骨折线治疗后Pilon骨折的临床疗效

Clinical effect of peroneal fracture line in the treatment of posterior Pilon fracture

目的通过经腓骨骨折线治疗后Pilon骨折,并探讨其可行性及临床疗效。方法回顾性分析2017年1月至2019年7月采用经腓骨骨折线治疗26例患者资料,其中男11例,女15例;年龄28~69岁,平均42.2岁;坠落伤10例、摔伤9例、交通损伤7例;均为新鲜闭合骨折且合并腓骨骨折。俞光荣分型为Ⅰ型11例,Ⅱ型8例,Ⅲ型7例。AGH分型为Ⅰ型10例,Ⅱa型5例,Ⅱb型2例,Ⅲa型5例,Ⅲb型4例。所有病例均采用后外侧入路撑开腓骨骨折线方法治疗,术后采用Burwell-Charnley放射学评价标准评价骨折复位质量;末次随访时,采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分评价踝关节功能。结果26例患者术后均获得随访,随访时间12~23个月,平均14.9个月;骨折均获得骨性愈合,愈合时间3~6个月,平均4.0个月。术后根据Burwell-Charnley放射学评价标准评价骨折复位质量,其中解剖复位23例,复位可3例,解剖复位率为88%(23/26)。末次随访时,AOFAS踝与后足评分为80~100分,平均89.9分,其中优17例,良9例,优良率为100%(26/26)。末次随访时,无一例患者出现复位丢失、皮肤坏死、感染、内固定松动及踝关节僵直等并发症。结论经腓骨骨折线治疗后Pilon骨折能充分显露胫骨远端关节面和后踝骨折间隙,能直视下复位和固定,解剖复位率高,临床效果好且安全。

Objective To investigate the clinical effect of peroneal fracture line in the treatment of posterior Pilon fracture.Methods The data of 26 patients treated with fibular fracture line from January 2017 to July 2019 were analyzed retrospectively,including 11 males and 15 females;the age ranged from 28 to 69 years,with an average of 42.2 years.There were 10 cases of falling injury,9 cases of falling injury and 7 cases of traffic injury;all of them were fresh closed fibular fractures;According to Yu Guangrong's classification,there were 11 cases of type I,8 cases of type II and 7 cases of type III;AGH was divided into 10 cases of type I,5 cases of type IIa,2 cases of type IIb,5 cases of type IIIa and 4 cases of type IIIb.All cases were treated by opening the fibular fracture line through the posterolateral approach,the quality of fracture reduction was evaluated by Burwell Charnley radiological evaluation standard after operation;At the last follow-up,ankle function was evaluated by American Association of Foot and Ankle surgery(AOFAS)ankle and hindfoot scores.Results All 26 patients were followed up for 12-23 months,with an average of 14.9 months;Bone healing was achieved in all fractures.The healing time was 3-6 months,with an average of 4.0 months.The quality of fracture reduction was evaluated according to the Burwell Charnley radiology evaluation standard after operation,including anatomical reduction in 23 cases and acceptable reduction in 3 cases.The anatomical reduction rate was 88%(23/26).At the last follow-up,AOFAS ankle and hindfoot scores ranged from 80 to 100,with an average of 89.9 points,of which 17 cases were excellent and 9 cases were good,and the excellent and good rate was 100%.At the last follow-up,no patient had complications such as reduction loss,skin necrosis,infection,internal fixation loosening or ankle stiffness.Conclusion After the treatment of Pilon fractures via peroneal fracture line,the distal tibial articular surface and posterior ankle fracture gap can be fully exposed,which can be repositioned and fixed under direct vision,with high anatomical repositioning rate and good and safe clinical results.