Department of Orthopedics, The Second Hospital of Jilin University, Changchun, 130041, China.
Orthopaedic Research Institute of Jilin Province, Changchun, 130041, People's Republic of China.
BMC Musculoskelet Disord. 2020 Mar 18;21(1):176. doi: 10.1186/s12891-020-03207-3.
Poor prognosis was reported for complex Pilon fractures involving severe soft tissue damage. It is therefore useful to explore the evolution of different treatment strategies in an effort to reconstruct the axial alignment and articular surface, while minimizing additional damage to the surrounding soft tissues.
Seventeen patients with Pilon fractures were enrolled in this retrospective study from December 2009 to October 2014. The injuries were graded according to AO Classification and the Gustilo-Anderson system. Patients were treated with minimally invasive plate osteosynthesis (MIPO) combined with curved incision on the anterior area of ankle. The ankle function and radiological outcome were assessed by the modified Mazur ankle score and Burwell-Charnley criteria, respectively. Visual analogue score (VAS) score was used to assess the degree of patient's ankle pain, and related complications were also recorded.
The mean time for fracture healing was 3.6 months (range: 3-6 months). According to Mazur's criteria, surgical treatment achieved good or excellent outcome in 15 (88.2%) cases, and the average VAS score was 1.19 ± 0.52. On the basis of Burwell-Charnley score, 12 (70.5%) patients achieved anatomic recovery, 4 (23.5%) obtained good reduction, and only 1 (5.9%) patient was diagnosed with valgus deformity. Additionally, 1 (5.9%) patient developed a superficial infection around incision, and 2 (11.8%) experienced superficial peroneal nerve damage. In addition, 2 (11.8%) patients showed radiographic evidence of existing ankle osteoarthritis at the final follow-up.
This retrospective study is the first to assess the application of a curved incision on the anterior area of ankle with MIPO for the treatment of Pilon fractures, which achieves high functional recovery with a low complication rate. However, large randomized controlled trials comparing different approaches and fixation methods are still needed to conclusively identify the optimal treatment protocol.
涉及严重软组织损伤的复杂 Pilon 骨折预后较差。因此，探索不同治疗策略的演变以努力重建轴向对线和关节面，同时最大限度地减少周围软组织的进一步损伤是有用的。
本回顾性研究纳入了 2009 年 12 月至 2014 年 10 月期间的 17 例 Pilon 骨折患者。根据 AO 分类和 Gustilo-Anderson 系统对损伤进行分级。患者采用微创钢板接骨术（MIPO）联合踝关节前区弧形切口治疗。采用改良 Mazur 踝关节评分和 Burwell-Charnley 标准分别评估踝关节功能和影像学结果。视觉模拟评分（VAS）用于评估患者踝关节疼痛程度，记录相关并发症。
骨折愈合平均时间为 3.6 个月（范围：3-6 个月）。根据 Mazur 标准，15 例（88.2%）手术治疗获得良好或优秀结果，平均 VAS 评分为 1.19±0.52。根据 Burwell-Charnley 评分，12 例（70.5%）患者获得解剖复位，4 例（23.5%）获得良好复位，仅 1 例（5.9%）患者诊断为外翻畸形。此外，1 例（5.9%）患者切口周围出现浅表感染，2 例（11.8%）患者出现腓浅神经损伤。此外，最终随访时 2 例（11.8%）患者出现踝关节骨关节炎的影像学证据。
本回顾性研究首次评估了踝关节前区弧形切口结合 MIPO 治疗 Pilon 骨折的应用，该方法功能恢复良好，并发症发生率低。然而，仍需要大样本随机对照试验比较不同方法和固定方法，以明确最佳治疗方案。
