Kim Gi Beom, Shon Oog-Jin, Park Chul Hyun
1 Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
2 Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea.
Foot Ankle Int. 2018 Apr;39(4):426-432. doi: 10.1177/1071100717746628. Epub 2018 Jan 23.
The purpose of this study was to evaluate the clinical and radiographic results of the treatment of AO/OTA type C pilon fracture via the anterolateral approach using a low-profile plate combined with medial minimally invasive plate osteosynthesis (MIPO).
We retrospectively reviewed 28 ankles with AO/OTA type C pilon fractures that were treated using the anterolateral approach combined with medial MIPO. Mean age was 46 years (range, 19 to 75), and the mean follow-up period was 25 months (range, 14 to 50). Clinical results were assessed using the visual analogue scale (VAS) and the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale. Range of motion (ROM) of the ankle joint was measured, and postoperative complications were investigated via chart review.
The VAS and AOFAS Ankle-Hindfoot Scale were 2 and 89, respectively, at the last follow-up. Ankle ROM at the last follow-up was 13 degrees (range, 5 to 20) in dorsiflexion and 38 degrees (range, 35 to 40) in plantarflexion. All the fractures united without additional surgery. One patient (3.6%) had a deep infection at the fibular fracture site, and 1 patient (3.6%) had partial skin necrosis.
This combined technique for AO/OTA type C pilon fracture resulted in good ROM of the ankle joint with reasonable function with a fairly low wound complication rate. However, further research on defined indications with a comparison group from multiple centers is necessary to determine if this technique is better than alternative surgical approaches.
Level IV, case series.
本研究旨在评估采用前外侧入路联合内侧微创钢板接骨术（MIPO），使用低轮廓钢板治疗AO/OTA C型pilon骨折的临床和影像学结果。
我们回顾性分析了28例采用前外侧入路联合内侧MIPO治疗的AO/OTA C型pilon骨折患者。平均年龄46岁（19至75岁），平均随访时间25个月（14至50个月）。使用视觉模拟量表（VAS）和美国矫形足踝协会（AOFAS）踝-后足量表评估临床结果。测量踝关节活动范围（ROM），并通过病历审查调查术后并发症。
末次随访时，VAS和AOFAS踝-后足量表评分分别为2分和89分。末次随访时踝关节背屈ROM为13度（5至20度），跖屈ROM为38度（35至40度）。所有骨折均未进行二次手术而愈合。1例患者（3.6%）在腓骨骨折部位发生深部感染，1例患者（3.6%）出现部分皮肤坏死。
这种治疗AO/OTA C型pilon骨折的联合技术可使踝关节获得良好的活动范围和合理的功能，伤口并发症发生率较低。然而，需要进一步开展多中心的对照研究，明确适应证，以确定该技术是否优于其他手术方法。
IV级，病例系列研究。
