后Pilon骨折应用后外侧入路治疗体会  

Surgical treatment for posterior Pilon fracture through posterolateral approach

作　　者：贾少华[1] 黄成龙[1] 徐红伟[1] 龚遂良[1] 

机构地区：[1]嘉兴学院附属第二医院足踝外科,浙江嘉兴314001

出　　处：《中国骨伤》2016年第6期557-560,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的 ：探讨后外侧入路切开复位内固定（ORIF）治疗后Pilon骨折的临床疗效。方法：自2010年2月至2013年4月,采用后外侧入路治疗17例后Pilon骨折患者,均涉及胫骨远端关节面超过20%,其中男11例,女6例;年龄29~59岁,平均43.4岁。致伤原因：11例坠落伤,4例车祸伤,2例运动损伤。根据俞光荣后方Pilon骨折的分型,Ⅰ型6例,Ⅱ型5例,Ⅲ型6例。观察骨折愈合时间、骨折复位情况及术后并发症情况,并采用AOFAS评分对其临床疗效进行评估。结果：17例患者均获得随访,时间13~24个月,平均20.5个月。后外侧切口均Ⅰ期愈合。所有病例获得骨性愈合,骨折愈合时间12~21周,平均15.2周。术后未出现切口感染、神经血管损伤、骨不连及骨折畸形等并发症。根据AOFAS评分标准,总分92.0±10.1,优14例,良2例,一般1例。结论：后外侧入路能在直视下对后Pilon骨折块进行有效复位及可靠固定,操作安全、简单,是治疗后方Pilon骨折的有效方法,值得推广。Objective ：To explore clinical results of open reduction and internal fixation （ORIF） for posterior Pilon fracture through posterolateral approach. Methods：Seventeen patients with posterior Pilon fracture were treated through posterolateral approach from February 2010 to April 2013. Among them,including 11 males and 6 females aged from 29 to 59 with an average of 43.4 years old. All fractures were associated with more than 20% of articular surface of distal tibial. The causes of injury included falling down （11 cases ）, traffic accident （4 cases） and sports injury （6 cases）. Fracture classification was based on posterior pilon fracture by YU Guang-rong,inchding type Ⅰ （6 cases） ,type Ⅱ （2 cases） and type Ⅲ （6 cases）. Fracture healing time, fracture reduction and postoperative complications were observed, AOFAS score were applied to evaluate clinical efficacy. Results：All patients were followed up from 13 to 24 months with an average of 20.5 months. All incisions were healed at stage Ⅰ ,and fractures obtained healing,the time of fracture healing ranged from 12 to 21 weeks with an average of 15.2 weeks. No incision infection ,neurovascular injury ,bone ununion and fracture deformity were found after operation. Postoperative AOFAS score was 92.0±10.2, and 14 cases got excellent results, 2 good and 1 moderate. Conclusion： Posterior pilon fracture through posterolateral approach could obtain effective reduction, stable fixation. It is a safe, simple and effective operation for treating posterior Pilon fracture, and it is worth popularizing.

关 键 词：胫骨骨折 骨折固定术 内 骨牵引复位法 

分 类 号：R683.42[医药卫生—骨科学]