单一前外侧切口治疗Pilon骨折的初步报告

目的介绍一种单一前外侧切口治疗Pilon骨折的适应证、方法及初期随访结果。方法 2008年3月至2010年3月,应用单一前外侧切口治疗12例闭合性胫骨Pilon骨折患者。男性8例,女性4例;年龄18~48岁,平均28岁。采用分期治疗方法,伤后至手术时间5~14 d,平均7.1 d。按AO/OTA分型,43-B型4例,43-C型8例,切口位于腓骨前缘,至腓骨远端后斜向第四跖骨方向,腓动脉穿支需结扎或避开,注意横跨切口的腓浅神经分支,显露胫腓骨远端,切开关节囊,显露踝关节辅助复位。术后伤口愈合后开始不负重踝关节功能锻炼,负重时间由随访决定。结果 1例伤口发生部分坏死,自行愈合,其余伤口均按期拆线。按Mazur评定标准评估疗效,优8例,良3例,可1例。结论应用单一前外侧切口不能适用于所有Pilon骨折,但对合适病例能够减少软组织并发症,并利于胫骨关节面的复位。

The Use of A Aingle Anterolateral Approach for the Treatment of Pilon Fracture Preliminary Report

Objectives To introduce the indications and operative procedure of a single anterolateral approach for the treatment of Pilon fracture and report its preliminary results.Methods 12 cases with closed unilateral tibial pilon fracture were treated with a single anterolateral approach between March 2008 and March 2010.There were 8 males and 4 femals.The average age was 28 years(range 18 to 48 years).According to the AO/OTA classification,there were type 43-B in 4 cases and type 43-C in 8 cases.A lateral skin incision is made along the anterial border of the fibula to the end of fibula then toward the base of the fourth metatarsal.The anterior perforating peroneal artery can be identified and preserved.Be care of protecting the superficial peroneal nerve.Further blunt dissection is used to expose the distal parts of the tibia and fibula.Then the anterior ankle joint capsule is released to assist the reduction.Patients began to do exercise when the wound were completely healed.Standard postoperative weightbearing restrictions were maintained until evidence of healing was present.Results Partial skin necrosis curing without any treatment was found in 1 case,the others were all healed completely.Accoding to the Mazur critical,the results was evaluated as exerllent in 8 cases,good in 3 cases and fair in 1 cases.Conclusion A single anterolateral approach is not suitable for all patients to these difficult fractures.But this approach preduce soft-tissue complications and is helpful to reconstruction of the articular surface of the distal tibia.