以往,后 Pilon 骨折被归纳为一般的后踝骨折或 Pilon 骨折中的一种亚型,直到 2000 年才逐渐引起关注。后 Pilon 骨折通常为足在跖屈位时同时受到垂直应力和旋转应力所致,若按一般的后踝骨折处理,治疗常常失败。由于其处理复杂、预后差,必须引起临床医师的重视。 横断面解剖:T 胫骨;F 腓骨;AT 跟腱;FHL 踇长屈肌腱;† 横肌间隔; * 胫后血管神经束。图源:DOI: 10.1097/BOT.0000000000000218. CT 可进一步显示骨折详情,比如后踝骨块数目形态、内踝累及情况、die-punch 骨折块、下胫腓有无增宽等。图源:DOI: 10.1177/1071100712469334. 如有胫距关节的半脱位,急诊的手法复位以及临时石膏固定是有益的。皮肤出现皱褶,意味着手术时机的到来。 后外侧或后内侧入路是常用手术入路,后续学者又在此基础上进行一定改良;此外,还可使用后外-内侧联合入路。详见链接:后踝和后 Pilon 骨折暴露让人头疼?5 分钟看懂手术入路! 作者:阿 C 题图:文末文献 参考文献 1、HansenST. Functional reconstruction of the foot and ankle[M]. Philadelphia, USA: Lippincott Williams & Wilkins, 2000: 37-46. 2、Assal M, Ray A, Stern R. Strategies for surgical approaches in open reduction internal fixation of Pilon fractures. J Orthop Trauma. 2015 Feb;29(2):69-79. doi: 10.1097/BOT.0000000000000218. PMID: 25072286. 3、Klammer G, Kadakia AR, Joos DA, Seybold JD, Espinosa N. Posterior Pilon fractures: a retrospective case series and proposed classification system. Foot Ankle Int. 2013 Feb;34(2):189-99. doi: 10.1177/1071100712469334. Epub 2013 Jan 22. PMID: 23413057. 4、Chaparro F, Ahumada X, Urbina C, Lagos L, Vargas F, Pellegrini M, Barahona M, Bastias C. Posterior Pilon fracture: Epidemiology and surgical technique. Injury. 2019 Dec;50(12):2312-2317. doi: 10.1016/j.injury.2019.10.007. Epub 2019 Oct 4. PMID: 31630782. 5、Zhang J, Wang H, Pen C, Qu WC, Duan L, Ren J, Li L, Liu Z, Sun T. Characteristics and proposed classification system of posterior Pilon fractures. Medicine (Baltimore). 2019 Jan;98(3):e14133. doi: 10.1097/MD.0000000000014133. PMID: 30653144; PMCID: PMC6370166. 6、俞光荣, 陈大伟, 赵宏谋, 等. 支撑钢板固定后侧 Pilon 骨折的疗效分析. 中华创伤杂志,2013,29(3):243-248. DOI:10.3760/cma.j.issn.1001-8050.2013.3.015. 7、Anwar A, Hu Z, Adnan A, Gao Y, Li B, Nazir MU, Tian C, Wang Y, Lv D, Zhao Z, Zhang Z, Zhang H, Tong C, Lv G. Comprehensive biomechanical analysis of three clinically used fixation constructs for posterior malleolar fractures using cadaveric and finite element analysis. Sci Rep. 2020 Oct 29;10(1):18639. doi: 10.1038/s41598-020-75819-7. PMID: 33122787; PMCID: PMC7596231. 8、Verhage SM, Leijdesdorff A, Schipper IB, Hoogendoorn JM. Open reduction and internal fixation of the posterior malleolus fragment via the posterolateral approach is radiologically superior to 'A to P' screw fixation. Foot (Edinb). 2022 May;51:101894. doi: 10.1016/j.foot.2021.101894. Epub 2021 Dec 23. PMID: 35255401. |
|