Pilon 骨折的分型与治疗进展

本文回顾了Pilon骨折的诊断、分型及治疗发展,Pilon骨折特点是高能量损伤累及踝关节负重关节面的胫骨远端骨折,常伴有腓骨骨折和下胫腓关节分离。20世纪中期Pilon骨折被认为无法通过内固定进行治疗,公认的方法是通过骨牵引使关节早期模造获得关节功能的恢复。20世纪后期随着AO理论的深入研究,学术界广泛认同所有关节内骨折的理想治疗方法是解剖复位、坚强固定和早期活动。此后,随着内固定技术的发展及骨科BO理论的出现,目前普遍认为Pilon骨折的治疗应遵循的原则是:1.寻求骨折稳固和软组织完整之间的一种平衡;2.不以牺牲局部软组织血供来强求达到坚强固定。

Classification and Treatment Progress of Pilon Fracture

This article reviewed development of the diagnosis,classfication and treatment of Pilon fracture.Pilon fracture is characterized by distal tibial fracture caused by high-energy injuries involving the ankle joint weight-bearing articular surface,which is frequently associated with fibula fracture and inferior tibiofibular joint separation.In the middle of 20th century,it was considered that Pilon fracture might not be treated by internal fixation.Skeletal traction was the only accepted method to get early restoration of joint function.With deep study of the AO theory in the late of 20th century,an ideal treatment which was widely accepted by academia is that intra-articular fracture should be treated by anatomical reduction,rigid fixation and early mobilization.Since then,with the development of fixation and the emergence of BO theory,we widely accepted that the principle of Pilon fracture treatment should be abided by two following rules: the first is a balance maintained between stability of fracture and integrity of soft tissue;the second is that losing local blood supply of soft tissue should not be allowed for firm fixation.