摘要
目的:探讨前pilon骨折的定义及其五柱分型理论,进而指导手术方案选择并验证其临床效果。方法:回顾性分析2012年6月至2021年8月收治的45例前pilon骨折患者(共47处骨折,其中2例为双侧)临床资料。根据骨折的影像学特点及受伤机制,重新定义前pilon骨折,并基于胫腓骨远端的解剖结构特点,将前pilon骨折分为五柱。骨折复位内固定术后采用Burwell-Charnley影像学标准评估骨折复位情况,采用美国足踝外科协会踝-后足评分(AOFAS-AHS)评估踝关节功能。结果:47处前pilon骨折累及五柱分型的内侧柱27处、前内侧柱37处、前外侧柱38处、外侧柱25处,后柱25处。其中单柱骨折6处,双柱骨折4处,三柱骨折15处、四柱骨折17处、五柱骨折5处。术后Burwell-Charnley影像学评估解剖复位率89.4%。45例患者中41例获得9~95个月的随访,平均(24.2±20.6)个月。骨折愈合时间3.0~4.5个月,平均(3.5±0.5)个月。术后AOFAS-AHS平均(90.0±5.8)分,优良率95.3%。结论:前pilon骨折的确切定义及五柱分型有助于提供治疗策略指导并获得良好的临床疗效。
Objective:To investigate the concept of anterior pilon fracture and the clinical efficacy of a novel five-column classification system in guiding the surgical treatment of anterior pilon fracture.Methods:Clinical data of 45 patients(47 fractures)with anterior pilon fractures admitted in hospital from June 2012 to August 2021 were retrospectively analyzed.According to the injury mechanism and imaging characteristics,anterior pilon fracture was redefined and classified by a five-column method based on the anatomical characteristics of the distal tibia and fibula.Functional and radiographical outcomes were assessed postoperatively,with use of the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale(AOFAS-AHS)and Burwell-Charnley radiographic criteria,respectively.Results:Classified by the five-column method,the medial column,anterior medial column,anterior lateral column,lateral column,and posterior column were injured in 27,37,38,25 and 25 ankles,respectively,causing 6 single-column fractures,4 twocolumn fractures,15 three-column fractures,17 four-column fractures,and 5 all-five-column fractures.According to the BurwellCharnley criteria,the anatomical reduction was obtained in 89.4%fractures.Totally 41 patients were available for follow-up at a mean of(24.2±20.6)months(range,9-95 months)postoperatively.All the fractures healed within an average of(3.5±0.5)months(range,3.0-4.5 months).The mean AOFAS-AHS score was 90.0±5.8,with an excellent and good rate of 95.3%.Conclusions:Five-column classification system of anterior pilon fracture is helpful in guiding the selection of surgical plans and obtaining good clinical outcomes.
作者
孙洋
袁宝明
任广凯
王雁冰
常非
李晔
彭传刚
吴丹凯
SUN Yang;YUAN Baoming;REN Guangkai;WANG Yanbing;CHANG Fei;LI Ye;PENG Chuangang;WU Dankai(Orthopaedic Medical Center,the Second Hospital of Jilin University,Changchun 130022;Department of Orthopaedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)
出处
《中华骨与关节外科杂志》
2022年第12期951-957,共7页
Chinese Journal of Bone and Joint Surgery
基金
吉林省财政厅卫生专项(2020SCZT067)
关键词
踝关节骨折
PILON骨折
分型
治疗
Ankle Fractures
Pilon Fractures
Classification
Treatment
