前外侧单一切口治疗累及中、外侧柱Pilon骨折的疗效分析

作者	单位	邮编
王高强^*	启东市人民医院/启东肝癌防治研究所/南通大学附属启东医院,江苏启东,226200	226200
熊培康	启东市人民医院/启东肝癌防治研究所/南通大学附属启东医院,江苏启东,226200	226200
蔡春岳^*	启东市人民医院/启东肝癌防治研究所/南通大学附属启东医院,江苏启东,226200	226200
倪向阳	启东市人民医院/启东肝癌防治研究所/南通大学附属启东医院,江苏启东,226200	226200
李政	启东市人民医院/启东肝癌防治研究所/南通大学附属启东医院,江苏启东,226200	226200
刘敏杰	启东市人民医院/启东肝癌防治研究所/南通大学附属启东医院,江苏启东,226200	226200
杨勇	启东市人民医院/启东肝癌防治研究所/南通大学附属启东医院,江苏启东,226200	226200
季佳霏	启东市人民医院/启东肝癌防治研究所/南通大学附属启东医院,江苏启东,226200	226200
樊健	同济大学附属同济医院,上海,200333	200333

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中文摘要:

目的探讨前外侧单一切口治疗累及中、外侧柱Pilon骨折的临床效果与安全性。方法回顾性分析启东市人民医院自2023年1月至2024年8月收治的13例中、外侧柱Pilon骨折患者的临床资料。其中，男8例，女5例；年龄36～69岁，平均年龄为（47.8±10.5）岁；受伤侧别：左踝7例，右踝6例；根据AO/OTA分型标准，43B型8例，43C型5例。所有患者均采用仰卧位前外侧单一切口实施切开复位内固定术，术中根据骨折移位与软组织条件决定是否联合植骨。术后采用Burwell-Charnley标准评价骨折复位质量，随访期间评估骨折愈合时间、手术相关并发症及末次随访时的美国足踝外科协会（AOFAS）踝-后足功能评分。结果 13例患者均完成随访，随访时间为（14.8±3.3）个月。手术时间为（103.5±14.1）min，术中出血量为（94.2±41.5）mL，骨折临床愈合时间为（12.6±2.6）周。Burwell-Charnley放射学评分：优9例，可4例；末次随访AOFAS踝-后足功能评分为（87.5±6.9）分，其中优6例，良5例，可2例，优良率为84.6%。术后并发症方面，2例切口边缘张力性水肿，经换药后愈合；1例术后3个月出现轻度踝关节僵硬，经康复锻炼改善。未见内固定失败、切口感染及骨折不愈合等严重并发症。结论前外侧单一切口治疗累及中、外侧柱Pilon骨折在满足良好术野暴露的基础上，具备较低的软组织并发症发生率，能够实现解剖复位及良好功能恢复，是一种安全有效的手术方式，适用于中重度Pilon骨折的临床治疗。

英文摘要:

Objective To investigate the clinical efficacy and safety of the anterolateral single incision approach for the treatment of Pilon fractures involving the central and lateral columns.Methods A retrospective analysis was conducted on the clinical data of 13 patients with medial and lateral column Pilon fractures treated at Qidong People's Hospital from January 2023 to August 2024. Among them, 8 were males and 5 were females; ages ranged from 36 to 69 years, with an average age of (47.8±10.5) years old. Injury sides included 7 left ankles and 6 right ankles. According to the AO/OTA classification, there were 8 cases of type 43B and 5 cases of type 43C. All patients underwent open reduction and internal fixation through a single anterolateral incision in the supine position, with bone grafting performed if decided intraoperatively based on fracture displacement and soft tissue conditions. Postoperative fracture reduction quality was evaluated using the Burwell-Charnley criteria, and during follow-up, fracture healing time, surgery-related complications, and the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot functional scores at the last follow-up were assessed.Results All 13 patients completed follow-up, with a follow-up period of (14.8±3.3) months. The surgery duration was (103.5±14.1) min, and the average intraoperative blood loss was (94.2±41.5) mL. The clinical fracture healing time was (12.6±2.6) weeks. Burwell-Charnley radiographic scoring: 9 cases were excellent, 4 cases were good; at the last follow-up, the AOFAS ankle-hindfoot functional score was (87.5±6.9) points, with 6 cases rated excellent, 5 cases rated good, and 2 cases rated fair, giving an excellent-good rate of 84.6%. Postoperative complications included incisional edge tension edema in 2 cases, which healed after dressing changes; 1 case developed mild ankle joint stiffness 3 months postoperatively, which improved with rehabilitation exercises. No severe complications such as internal fixation failure, incision infection, or nonunion of fractures were observed.Conclusion The anterolateral single incision approach for Pilon fractures involving the central and lateral columns provides adequate surgical exposure, low rates of soft tissue complications, and enables anatomical reduction and functional recovery. It is a safe and effective surgical technique for the clinical management of moderate to severe Pilon fractures.

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