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目的 探讨经趾长屈肌和(踇)长屈肌间隙入路联合前侧入路治疗累及后Pilon的Rüedi-AllgSwerⅢ型骨折的手术适应证和临床疗效.方法 回顾性分析2014年1月至2015年3月,采用经趾长屈肌和(踇)长屈肌间隙人路联合前侧人路切开复位内固定治疗累及后Pilon的Rüedi-AllgowerⅢ型骨折16例,男11例,女5例;年龄19～62岁,平均43.5岁;高处坠落伤9例,车祸伤5例,走路摔伤2例;均合并胫骨远端后Pilon骨块.手术采用经趾长屈肌和踇长屈肌的间隙显露、复位固定后侧骨折块,根据前侧骨折块的位置选用前内侧、前正中或前外侧切口复位固定塌陷的关节面、前侧骨折块和腓骨骨折.术后采用Burwell-Charnley放射学评价标准评价骨折复位质量,采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分评价踝关节功能.结果 受伤至手术时间为10～20 d,平均14.3 d;手术时间120～240min,平均187.4 min;术中出血量100～500 ml,平均218 ml.16例患者均获得随访,随访时间12～24个月,平均16.1个月.骨折愈合时间为12～24周,平均16.7周.13例获得解剖复位,3例复位一般,解剖复位率为81.3％(13/16).术后1年AO-FAS踝与后足评分为57～94分,平均88.6分,优良率为87.5％(14/16).2例前侧切口术后分别出现浅表感染和皮缘部分坏死,经换药后愈合.结论 经趾长屈肌和踇长屈肌间隙入路联合前侧人路治疗累及后Pilon的Rüedi-AllgowerⅢ型骨折可获得良好复位和满意临床疗效,是一种可供选择的治疗方法.“,”Objective To explore the operation indication and clinical effect of combined modified posteromedial and anterior approaches for the treatment of Rüedi-Allgower type Ⅲ Pilon fractures.Methods From January 2014 to March 2015,data of 16 Pilon fractures was retrospectively analyzed.There were 11 males and 5 females,with an average age of 43.5 years old (range,19-62 years old).9 patients were fall injuries,5 patients were traffic injuries and 2 patients suffered from spraining injury.All of the fractures were closed type Ⅲ according to Rüedi-Allgower classification with posterior Pilon fragment involved.A modified posteromedial approach,exploring fracture between flexor digitorum longus and flexor hallucis longus tendon,was employed to reduce and fix the posteromedial fragment,and an anterior approach (anteromedial,anterior intermediate,or anterolateral incision) was employed to reduce and fix the fibular fracture,depressed and anterior fragment.Burwell-Charnley radiological evaluation system and American Orthopaedic Foot and Ankle Society (AOFAS) functional scoring system were used for radiological and functional assessment respectively.Results The average time from injury to operation was 14.3 days (range10 to 20 days).Operating time was 120-240 min with an average time of 187.4 min.Intraoperative blood loss was 150-300 ml with an average of 218 ml.All patients were followed up,and the average duration of follow-up was 16.1 months (range,12-24 months).Fracture healing time was 12-24 weeks with an average of 16.7 weeks.13 patients got anatomical reduction,and 3 good reduction,with an anatomical reduction rate of 81.3％ (13/16).The average AOFAS scale was 88.6,with an excellent good rate of 87.5％ (14/16).Skin infection occurred in 1 patient and incision edge necrosis in 1 patient,which healed through dressing and debridement treatment.Conclusion Combined modified posteromedial and anterolateral approaches is a safe and effective method for the treatment of RüediAllgower type Ⅲ Pilon fractures,which can be recommended in clinical practice.