踝关节镜监视下微创治疗胫骨Pilon骨折

目的探讨在关节镜监视下微创钢板内固定技术治疗胫骨Pilon骨折的临床疗效.方法采用关节镜监视下小切口撬拨复位、微创经皮钢板固定技术（MIPPO）治疗32例胫骨Pilon骨折患者.结果所有病例创口愈合良好，均在术后2周拆线.27例获得随访，时间3～19（9．5±6．2）个月.骨折临床愈合时间为8-17（10．3±3．7）周，无骨折不愈合：随访X线显示骨折对位对线良好，无畸形愈合：植骨区骨痂生长良好，新生骨与植入骨紧密结合.3例胫骨远端关节面尚不平整，出现轻度骨关节炎的表现，1例主诉长距离行走后踝关节肿痛.按Mazur等踝关节症状和功能评分系统进行疗效评定：优14例，良12例，可1例.结论关节镜监视下小切口撬拨复位，尽可能使重建后的踝关节面接近正常解剖．可防止创伤性踝关节炎的发生，临床效果满意．

Arthroscopy-assisted minimally invasive plate fixation of tibial Pilon fractures

Objective To explore optimal surgical techniques and clinical outcome of Pilon fractures managed with arthroseopy-assisted minimally invasive plate fixation. Methods 32 patients with Pilon fractures was treated. Under arthroscopy, the fracture reduction was achieved within a small incision by the poking technique and then the plate was implanted with the minimally invasive percutaneous plate osteosynthesis （MIPPO） techniques. Results 27 patients were followed up for 3 - 19（9. 5 ±6. 2） months. Healing of incisions and fractures was achieved in all cases. Radiologically, the fracture segments got satisfactotT reduction with good apposition and alignment. New bone formation and hone callus were found in the grafting area, and good integration existed in the graft and new bone. The time of fracture union was 8 to 17 （ 10. 3 ± 3.7） weeks. No malunion or nonunion was observed. Rough joint surface of distal tibia and slight osteoarthritis was seen in 3 cases and only 1 case complained swelling and pain in ankle joint after a long walk. There were 14 excellent, 12 good and 1 fair ranked by the Mazur ankle evaluation grading system. Conclusions Anatomic reduction of ankle joint surface can be achieved by arthroscopy-assisted poking reduction so as to prevent traumatic osteoarthritis of ankle joint.