Modified staging strategy in treatment of type C3 Pilon fractures

Objective: To investigate the safety, feasibility, and effectiveness of modified staging strategy in treatment of type C3 Pilon fractures. 方法: 回顾分析 2012 年 1 月—2018 年 1 月采用改良分期分部策略治疗的 23 例 C3 型 Pilon 骨折患者临床资料。男 14 例，女 9 例；年龄 22～61 岁，平均 47.9 岁。23 例均为高能量损伤，其中交通事故伤 11 例、高处坠落伤 12 例。1 例为 Gustilo ⅢA 型开放骨折，经早期扩创后创面未见明显感染征象；其余患者均为闭合骨折。受伤至入院时间 3～40 h，平均 16.4 h。术前疼痛视觉模拟评分（VAS）为（7.22±1.17）分，美国足踝外科协会（AOFAS）评分为 0 分。踝关节背伸、跖屈活动度分别为（1.13±0.26）、（4.79± 0.93）°。22 例合并腓骨骨折。一期采用后方入路复位胫骨后柱骨折、外支架临时辅助固定；待软组织危象解除后，二期经前方入路行最终复位内固定。. Results: All 23 patients were followed up 12-84 months with an average of 26.6 months. The waiting time before the first-stage operation was 4-47 hours with an average of 23.4 hours. The interval between the two stage operations was 6-11 days with an average of 7.9 days. The first-stage operation time was 60-90 minutes with an average of 67.8 minutes; the second-stage operation time was 110-160 minutes with an average of 124.1 minutes. The hospital stay was 15-28 days with an average of 23.5 days. One patient (4.35%) had a tourniquet paralysis symptom after the second-stage operation, and two patients (8.7%) had delayed anterior incision healing. The other patients had incision healing without early complications. The radiographic review showed that the quality of articular surface reduction was excellent in 19 cases, good in 2 cases, and poor in 2 cases, with an excellent and good rate of 91.3%. At last follow-up, the fractures healed with no bone nonunion and malunion; the different degrees of osteoarthritis occurred in 7 cases. At last follow-up, the VAS score was 0.89 ±0.88 and the AOFAS score was 81.3±7.8. The flexion and plantar flexion activities of ankle joint were (10.23±5.05) and (20.97±3.92)°, respectively, and the differences between pre- and post-operation were significant ( P<0.05). 结论: 改良分期分部策略中一期胫骨后柱固定及减压为二期手术提供了关节面复位模板，提高了复位质量，还缩短了两期手术间隔时间和二期手术时间，能获得较好疗效。.