足踝与运动医学中心 病例54岁女性,高处坠落伤 诊 断(右胫骨Pilon骨折) 一AO/OTA分型———— 1996 一四柱理论 TANG Xin, TANG Pei-fu, WANG Man-yi, et al. Pilon fractures: a new classification and therapeutic strategies. Chinese Medical Journal, 2012; 125(14): 2487-2492 一基于损伤机制的分型Wei SJ, Han F, Lan SH, Cai XH*. Surgical treatment of pilon fracture based on ankle position at the time of injury/initial direction of fracture displacement: a prospective cohort study. Int J Surg.2014;12(5):418-25. 一Pilon骨折的手术切口Pilon Fractures Advances in Surgical Management (JAAOS 2011)这个病人面临的问题?入路的选择? 内固定物放置? 前内侧入路的特点胫骨Pilon骨折切口复位内固定《世界骨科标准手术技术丛书:骨折》The Extensile Approach for the Operative Treatment of High-Energy Pilon Fractures(JOT2007) 前外侧入路的特点Anterolateral Approach for Tibial Pilon Fractures (Orthopedics2012) 后外侧入路的特点 A Surgical Approach to Posterior Pilon Fractures 《JOT2008》 后内侧入路的特点Hansen S Jr. FunctionalReconstruction of the Foot and Ankle. Philadelphia, PA: LippincottWilliams & Wilkins; 2000:43–64.(红色箭头) Assal M, Ray A, Fasel JHD, etal. A Modified Posteromedial Approach Combined With Extensile Anterior for the Treatment of Complex Tibial Pilon Fractures (AO/OTA 43-C). J Orthop Trauma. 2014;6(28):e138-45. (绿色箭头) 魏世隽、蔡贤华:经后内侧入路VLP接骨板内固定治疗胫骨后pilon骨折.《中国修复重建外科杂志》2014;5(蓝色箭头)一手术入路设计