后外侧入路在Pilon骨折治疗中的应用

目的:评价在Pilon骨折治疗中后外侧入路的作用和并发症。方法:2009年8月至2011年3月,分期手术治疗15例Pilon骨折,AO/OTA分类B3型2例,其余均为C型骨折,均合并明显移位的后踝骨折。其中男12例,女3例,平均年龄37.9岁(21～51岁)。所有患者I期急诊手术使用超关节外固定架固定,Ⅱ期固定时首先通过后外侧入路固定腓骨,同时辅助复位和固定胫骨远端的后方骨折块,通过前内侧或前外侧入路复位和固定胫骨远端。结果:15例患者均获随访,平均随访时间14.2个月(12～17个月),13例骨折顺利愈合,2例需Ⅱ期自体髂骨植骨。后外侧伤口均未出现软组织并发症。术后影像学检查,14例关节面残留移位小于2mm。根据Baird-Jackson评价,优2例,良7例,可4例,差2例。结论:作为Pilon骨折前方入路的辅助切口,通过后外侧入路可以有效显露及固定后踝骨块及腓骨骨折,为前方骨折块的复位提供了标志,操作安全、简单、有效。

Posterolateral approaches for treatment of Pilon fractures

Objective:To evaluate the effect and complication of surgical treatment for Pilon fracture using the posterolateral approach. Methods:From August 2009 to March 2011,15 patients with Pilon fractures (2 in B3,13 in C) and with a separate displaced posterior malleolar fragment was treated in two-stage:the first stage management was on stabiliztion of the soft tissue envelope with temporary external fixator of spanning arthritis,and the second stage management was open reduction and internal fixation with posterolateral approach and anteromedial or anteralateral approach. Results:All patients were followed-up for 12 to 17 months (14.2 months in average). Thirteen of the 15 fractures healed,but 2 fractures needed autologous bone graft procedure duo to nonuion. There was no wound complication related to poterolateral incion. Fourteen fractures had less than 2 mm of incongruity of distal tibia joint. According to Baired-Jackson criteria,the results were excellent in 2 cases,good in 7,fair in 4,and poor in 2. Conclusion:The posterolateral approach offers direct visualization for the reduction and fixation of the fibula and posterior distal fragment of the tibia Pilon fractures,faciliate the management of this difficult fracture pattern.