AGH分型指导胫骨后Pilon骨折个体化治疗的临床疗效分析

目的 探讨AGH分型指导胫骨后Pilon骨折个体化治疗的临床疗效。方法 回顾性分析2017年3月至2020年4月苏州大学附属张家港医院收治的19例胫骨后Pilon骨折病人的临床资料，其中男9例，女10例，平均年龄为49.89岁（24~67岁），行走跌倒14例，交通伤4例，重物砸伤1例。所有病人行CT检查，根据CT及AGH分型结果采用不同的手术入路和内固定方法。术后采用Burwell-Charnley放射学标准评价踝关节面的复位情况，同时采用美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society，AOFAS）踝与后足功能评分系统和疼痛视觉模拟量表（visual analogue scale，VAS）评价病人踝关节功能恢复情况。结果 病人术中平均失血量为64.74 mL，手术时间平均为129.47 min。病人均获得随访，平均随访时间为15.79个月（12~24个月）。根据Bruwell-Charnley评价标准评估术后踝关节面复位质量：优13例，可6例。术后1年AOFAS评分平均为85.95分，VAS评分平均为1.11分。结论 胫骨后Pilon骨折根据受伤机制，骨折类型多样，结合CT及AGH分型指导胫骨后Pilon骨折分型及个体化治疗后临床疗效满意。

Clinical Efficacy of Individualized Treatment for Posterior Pilon Fracture Using AGH Classification

Objective To explore the clinical efficacy of individualized treatment for posterior Pilon fracture using AGH classification. Methods Data of 19 consecutive patients with posterior Pilon fractures who were treated in Zhangjiagang Hospital Affiliated to Soochow University from March 2017 to April 2020 were retrospectively analyzed. There were 9 males and 10 females with the average age of 49.89 years (range: 24 to 67 years). The mechanisms of injury were as follows: fall from standing height in 14 cases, traffic accident in 4 cases, and bruise in one case. All the patients were examined by CT scan, then respective surgical approach and implant was decided according to the CT images and AGH classification. The Burwell-Charnley radiographic criteria were used to assess the postoperative reduction quality. The American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) score were applied to assess ankle function recovery of patients. Results The average blood loss was 64.74 mL and the average operation time was 129.47 min. All patients were followed up for an average of 15.79 months (12-24 months). According to the Burwell-Charnley radiographic criteria after surgery, 13 cases obtained anatomical reduction and 6 cases obtained fair reduction. The mean AOFAS score was 85.95 points and the mean VAS score was 1.11 points one year after surgery. Conclusion The mechanism of injury for posterior Pilon fracture varies. CT scan combined with AGH classification is valuable for the classification and individualized treatment of the posterior Pilon fracture, and this strategy can obtain satisfactory clinical outcome.