Stillhard P F, Frima H, Sommer C
Klinik für Unfallchirurgie, Departement Chirurgie, Kantonsspital Graubünden, Chur, Schweiz.
Oper Orthop Traumatol. 2018 Dec;30(6):435-456. doi: 10.1007/s00064-018-0570-8. Epub 2018 Oct 17.
The majority of pilon or tibial plafond fractures are complex articular fractures and the treatment strategy, including the choice of the ideal surgical approach, is essential for a good functional outcome. In this paper, we discuss the considerations for dealing with such fractures as well as the pro and cons of the different approaches. The standard protocol consists of a two-staged procedure following the slogan span-scan-plan. After applying an ankle-spanning external fixator (span), the diagnostic work-up is completed by a CT scan with axial views, two-dimensional and three-dimensional reconstruction (scan) to fully understand the fracture pattern. Using this information, in coordination with the soft tissue situation, the ideal approaches, type and position of implants are planned in detail. This article, supported by clinical cases, describes different surgical approaches and the areas of interest which can be seen through these approaches as well as the implant position.
大多数Pilon骨折或胫骨平台骨折是复杂的关节骨折，治疗策略，包括理想手术入路的选择，对于良好的功能预后至关重要。在本文中，我们讨论了处理此类骨折的注意事项以及不同入路的优缺点。标准方案包括遵循“撑开-扫描-规划”口号的两阶段手术。应用跨踝关节外固定架（撑开）后，通过CT扫描及轴向视图、二维和三维重建（扫描）完成诊断性检查，以充分了解骨折类型。利用这些信息，并结合软组织情况，详细规划理想的入路、植入物的类型和位置。本文结合临床病例，描述了不同的手术入路、通过这些入路可以看到的感兴趣区域以及植入物位置。
