后踝骨折及后Pilon骨折的鉴别诊断及治疗进展

后踝骨折是由于踝关节受到旋转暴力所致下胫腓后韧带牵拉引起后踝撕脱性骨折,是一种低能量损伤,一般不累及关节面。后Pilon骨折是由于踝关节受到旋转暴力联合垂直压缩暴力导致胫骨远端后方的关节内骨折,由Hansen于2000年首次提出,易误诊。本文对后踝骨折及后Pilon骨折的定义、损伤机制、临床分型、检查及鉴别诊断、手术指征、手术时机、手术入路、复位顺序、固定方式、并发症及预后作一综述。

Progress in differential diagnosis and treatment of posterior malleolar fracture and posterior Pilon fracture

Posterior malleolar fracture is an avulsion fracture caused by ankle torsional force inducing posterior tibiofibular ligament traction, it is considered as low-energy injury, without articular damage involved. Whereas, posterior Pilon fracture is a distal posterior tibial fractures caused by ankle torsional force combined with axial compression force. Pilon fracture, first reported by Hansen in 2000, is a high-energy injury usually associated with significant articular cartilage damage, sometimes it is misdiagnosed as posterior malleolar fracture. The injury mechanism, treatments and prognosis of these two kinds of fractures are completely different. This article reviews the definition, injury mechanism, anatomical classification, physical examination, diagnosis, operative indication, operation timing, operative approach, fractures reduction sequence, internal fixation method, postoperative complications and prognosis of posterior malleolar fracture and posterior Pilon fracture.