改良后内侧入路结合后踝钢板治疗后Pilon骨折的疗效分析

The clinical effect of modified posteromedial approach combined with posterior malleolus plate on posterior Pilon fracture

目的探讨改良后内侧入路结合后踝钢板治疗后Pilon骨折的临床效果。方法回顾性分析中山大学附属第八医院于2020年1月至2022年1月诊治的35例后Pilon骨折病例资料,应用改良后内侧入路结合后踝钢板处理后踝骨折,通过踝关节X线片检查评估骨折复位情况,记录骨折愈合时间,随访评估患者患肢功能及并发症发生情况。末次随访采用美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分标准进行临床疗效评价。结果所有患者均获得随访,随访时间7~36个月,平均16.8个月,31例获得解剖或接近解剖复位,术后2例出现伤口愈合不良,加强换药后愈合,无医源性神经损伤、深静脉血栓等并发症,骨折均骨性愈合,愈合时间11~19周,平均13.9周,无内固定移动、松动或断裂。踝关节功能评分按AOFAS评分标准:优26例,良6例,一般3例,差0例,优良率91.43%。结论应用改良后内侧入路结合后踝钢板治疗后Pilon骨折固定牢固,后踝显露充分,骨折复位固定及踝关节功能恢复良好。

Objective To evaluate the clinical effect of modified posteromedial approach combined with posterior malleolus plate for posterior Pilon fracture.Methods A retrospective study was conducted in 35 patients with posterior Pilon fracture treated reduction and internal fixation through modified posteromedial approach combined with posterior malleolus plate in our hospital from January 2020 to January 2022.The operation time,bleeding volume and fracture healing time were recorded.The reduction was evaluated by X-ray.In the last follow-up,the American Orthopedic Foot and Ankle Society(AOFAS)ankle posterior function score was used to evaluate the clinical effect.Results All the 35 patients were followed up for average 16.8 months(7~36 months).X-ray showed 31 cases acquired anatomical reduction,2 cases had delayed healing and healed after dressing change.Other patients recovered well without iatrogenic nerve injury,DVT and other complications.All patients obtained bony union without internal fixation breakage and loosening.The mean bone healing time was 13.9 weeks(11~19 weeks).According to the AOFAS score,the excellent and good rate of the ankle function score was 91.43%.Conclusion The internal fixation with modified posteromedial approach combined with bracing technique for the treatment of posterior Pilon fracture is firm,fracture healing and ankle function recovery is good,and the treatment effect is satisfactory.