后外侧作为基础入路内固定治疗合并外踝骨折后Pilon骨折的效果分析

王蒙; 白克文; 彭军; 鲍磊; 周家宁; 齐红哲; 樊佳奇; 吴金超; 周雪峰

doi:10.16016/j.1000-5404.201904216

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后外侧作为基础入路内固定治疗合并外踝骨折后Pilon骨折的效果分析

临床医学 | 更新时间：2026-01-09

- 后外侧作为基础入路内固定治疗合并外踝骨折后Pilon骨折的效果分析
- Clinical outcomes of distal tibia posterior locking plate internal fixation for posterior Pilon fractures with lateral malleolus fracture through a combined posterolateral approach
- 第三军医大学学报 2019年41卷第18期页码：1802-1806
- 作者机构：
  
  100101 北京，战略支援部队特色医学中心(解放军306医院)骨科
- 作者简介：
  
  [ 周雪峰，电话:(010)66356729-2525，E-mail: 13911634680@126.com ZHOU Xuefeng, Tel: 86-10-66356729-2525, E-mail: 13911634680@126.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201904216
  中图分类号： R615;R683.42;R687.32
- 收稿：2019-04-29，
  
  修回：2019-06-27，
  
  纸质出版：2019-09-30
- 稿件说明：
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王蒙, 白克文, 彭军, 等. 后外侧作为基础入路内固定治疗合并外踝骨折后Pilon骨折的效果分析[J]. 第三军医大学学报, 2019,41(18):1802-1806.

Meng WANG, Kewen BAI, Jun PENG, et al. Clinical outcomes of distal tibia posterior locking plate internal fixation for posterior Pilon fractures with lateral malleolus fracture through a combined posterolateral approach[J]. Journal of Third Military Medical University, 2019, 41(18): 1802-1806.
王蒙, 白克文, 彭军, 等. 后外侧作为基础入路内固定治疗合并外踝骨折后Pilon骨折的效果分析[J]. 第三军医大学学报, 2019,41(18):1802-1806. DOI： 10.16016/j.1000-5404.201904216.

Meng WANG, Kewen BAI, Jun PENG, et al. Clinical outcomes of distal tibia posterior locking plate internal fixation for posterior Pilon fractures with lateral malleolus fracture through a combined posterolateral approach[J]. Journal of Third Military Medical University, 2019, 41(18): 1802-1806. DOI： 10.16016/j.1000-5404.201904216.

摘要

目的

探讨以后外侧入路为基础入路结合锁定接骨板治疗合并外踝骨折的后Pilon骨折的手术方法及疗效。

方法

回顾性分析2014年1月至2018年1月本院收治的59例合并外踝骨折的后Pilon骨折患者临床资料，男性33例，女性26例；年龄21~69岁，平均46.8岁。扭伤29例，高处坠落伤21例，车祸伤9例。左侧31例，右侧28例。俞光荣分型:Ⅰ型19例，Ⅱ型24例，Ⅲ型16例。所有患者采用以后外侧入路为基础入路结合锁定接骨板治疗，记录患者术后并发症、骨愈合及复位情况，采用美国足踝外科协会踝关节与后足功能评分对踝关节功能进行评估。

结果

59例患者平均随访18(12~30)个月。Burwell-Charnley标准评定骨折复位情况:解剖复位46例，良好9例，优良率93.2%；骨折平均愈合时间为11周(9~15.5周)；休息、运动及负重状态VAS评分均值分别为0.54、0.77、1.31；踝关节功能AOFAS评分结果:优45例，良11例，可3例，优良率94.9%；无感染、内固定失效、不愈合、畸形愈合等并发症。

结论

以后外侧入路为基础入路结合锁定接骨板治疗合并外踝骨折的后Pilon骨折，入路清晰，操作灵活，固定可靠，利于早期功能锻炼，术后并发症少，临床疗效满意。

Abstract

Objective

To explore the surgical method and the efficacy of posterolateral approach combined with locking plate for treatment of posterior Pilon fracture with lateral malleolus fracture.

Methods

We retrospectively analyzed the clinical data of 59 patients with posterior Pilon fracture complicated by lateral malleolus fracture treated in our hospital from January

2014 to January

2018

including 33 male and 26 female patients aged 21-69 years (mean 46.8 years). Among these cases

the fractures resulted from sprains in 29 cases

falling in 21 cases and traffic accidents in 9 cases; the fractures occurred on the left side in 31 cases and on the right in 28 cases. According to YU Guangrong's classification

19 patients had type Ⅰ

24 had type Ⅱ and 16 had type Ⅲ fractures. All the patients underwent distal tibia posterior locking plate internal fixation through a combined posterolateral approach

and the postoperative complications

bone healing time and fracture reduction were recorded; the ankle function was assessed based on the American Orthopaedic Foot and Ankle Society (AOFAS) score.

Results

The patients were followed up for 12 to 30 months (mean 18 months) after the operation. According to the Burwell-Charnley's criteria

anatomical reduction was achieved in 46 cases and good reduction in 9 cases

with an excellent and good reduction rate of 93.2%. The mean healing time of the fracture was 11 weeks (9-15.5 weeks). The mean VAS scores at rest

in motion and in weight bearing were 0.54

0.77 and 1.31

respectively. The ankle function

as evaluated according to AOFAS scores

was excellent in 45 cases

good in 11 cases

and acceptable in 3 cases

with an excellent and good function rate of 94.9%. No such complications as infection

failure of internal fixation

nonunion or malunion occurred during the follow-up.

Conclusion

The posterolateral approach combined with the locking plate

which has a clear surgical approach to allow flexible operation and reliable fixation

can achieve satisfactory clinical effect for treatment of posterior Pilon fracture with lateral malleolus fracture and promotes early functional recovery.

关键词

Keywords

references

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