[Effects of modified posteromedial approach combined raft technique for posterior Pilon fractures with collapsed articular surface].

Objective: To evaluate the effects of modified posteromedial approach combined raft technique in the treatment of posterior Pilon fractures with collapsed articular surface. Methods: A retrospective analysis was conducted on the clinical data of 51 patients with posterior Pilon fractures combined with collapsed articular surface treated in West China Hospital between January 2014 and June 2017. There were 30 males and 21 females with an average age of 49 years (range, 19-66 years).Subjective assessment of the results was performed according to the pain visual analog scale (VAS).The general function recovery was assessed with American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scale at the latest follow-up. The fracture reduction quality was determined according to Burwell-Charnley imaging standard by the anteroposterior(AP)/mortise X-ray view and three-dimensional CT of the ankle on the 3rd day after operation. The t-test was used to compare the normal distribution parameters. Results: Primary healing of incision and bone were obtained in all patients without loosening, breakage or infection of internal fixation in (3.7±0.7) months (range, 3-6 months). According to the Burwell-Charnley's standards, 50 cases achieved anatomical reduction, 1 case achieved fair reduction. According to AOFAS scales, the results were excellent in 41 cases, good in 9, and fair in 1; the excellent rate was 98.0%. According to the AOFAS scores, the average score was 93.6±2.2. The preoperative VAS score was 7.5±1.1, and the postoperative score was 0.3±0.7, in which the difference was statistically significant (t=31.231, P=0.000). At the last follow-up, the angle of injured side were 13.3°±3.4° in dorsal extension, 33.5°±4.7° in plantar flexion, and 46.9°±6.1° in the range, while angel of uninjured side were 19.8°±2.3°, 36.0°±5.7° and 55.6°±2.7°, respectively; there were significant differences in the up-mentioned indexes between the both sides (t=78.932, 121.231, 113.432, all P<0.05). Conclusion: Excellent short-term effectiveness can be achieved through the modified medial approach in patients with posterior Pilon fractures, which can be used to restore the ankle joint surface under direct vision; and with the raft technique, a small plate is used to fix small fragments firmly with less soft tissue complications.目的： 探讨经改良的后内侧入路联合支撑技术对后Pilon骨折的疗效。 方法： 回顾分析2014年1月至2017年6月在四川大学华西医院接受治疗的51例关节面塌陷的后Pilon骨折患者的临床资料。其中男30例，女21例；年龄19~66岁，平均49岁。根据视觉模拟疼痛量表（VAS）对结果进行主观评估。末次随访时使用美国骨科足踝外科中足评分（AOFAS）量表评估综合恢复情况。术后3 d拍踝关节正侧位、踝穴位X线片，行踝关节三维检查，根据Burwell-Charnley影像学标准判定骨折复位质量。正态分布参数前后比较使用t检验。 结果： 术后切口均Ⅰ期愈合。骨折均于术后3~6个月愈合，平均（3.7±0.7）个月。随访期间无内固定物松动、断裂、感染等并发症发生。术后依据Burwell-Charnley影像学标准判定骨折复位质量，获解剖复位50例，一般复位1例。末次随访时AOFAS量表踝关节功能评估，优41例，良9例，可1例，优良率98.0%。AOFAS踝与后足评分（93.6±2.2）分；患者术前VAS评分为（7.5±1.1）分，术后（0.3±0.7）分，手术前后相比差异有统计学意义（t=31.231，P=0.000）。末次随访术后患侧活动度背伸为13.3°±3.4°，跖屈为33.5°±4.7°，活动范围为46.9°±6.1°，而健侧则分别为19.8°±2.3°、36.0°±5.7°和55.6°±2.7°，两侧相比差异均有统计学意义（t=78.932、121.231、113.432，均P<0.05）。 结论： 对于后Pilon骨折，采用改良后内侧入路可直视下复位踝关节面，支撑技术结合小钢板，固定牢固，软组织并发症少，短期随访疗效满意。.