前内侧与前外侧入路内固定治疗C型pilon骨折的疗效比较

背景：C型pilon骨折多为高能量损伤造成,治疗困难。正确地选择手术入路至关重要。目的：比较前内侧与前外侧入路内固定治疗C型pilon骨折的疗效。方法方法：回顾分析2008年5月至2011年9月在我院行切开复位内固定治疗的C型pilon骨折43例的病例资料。男28例,女15例;年龄18-64岁,平均35.3岁。采用前内侧入路26例,前外侧入路17例。比较两组的手术时机、骨折愈合时间、Burwell-Charnley复位学放射学评价、Tornetta踝关节功能评价结果。结果：两组的手术时机、骨折愈合时间、术后即刻Burwell-Charnley复位解剖学评分、术后12个月Tornetta踝关节功能评分均无显著统计学差异（P〉0.05）。结论：Pilon骨折前外侧及前内侧入路手术在手术时机、骨折愈合时间、骨折复位效果及踝关节功能恢复方面并无差别。C型pilon骨折应依据骨折块的大小、位置及骨折断端的走向、移位和皮肤软组织条件选择手术径路。

Curative effect of anteromedial approach versus anterolateral approach for type C pilon fracture

Background： Type C pilon fracture is usually caused by high-energy injuries and the treatment is very difficult. Correct operative approach is closed related to therapeutic effect.Objective： To compare curative effects of internal fixation through anteromedial approach versus anterolateral approach for type C pilon fracture.Methods： A total of 43 patients with type C pilon fracture underwent open reduction and internal fixation between May2008 and September 2011. There were 28 males and 15 females with an average age of 35.3 years（range, 18-64 years）. The operation was performed through anteromedial approach in 26 cases and through anterolateral approach in 17 cases. Surgical timing, fracture healing time, Burwell-Charnley radiological score and Tornetta function scores of ankle joint were compared between two approaches.Results： There were no significant differences in surgical timing, fracture healing time, Burwell-Charnley radiological score,or Tornetta function scores of ankle joint between two approaches（P〉0.05）.Conclusions： There are no significant differences in surgical timing, fracture healing time, reduction quality or ankle joint function recovery between anterolateral approach and anteromedial approach for the treatment of type C pilon fracture. The choice of surgical approach should be based on injured bone size, position, fracture configuration, displacement and condition of skin and soft issue.