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目的 探讨后pilon骨折AGH分型及对手术入路和固定方式的临床指导意义.方法 2012年1月到2015年6月手术治疗后pilon骨折患者18例,男11例,女7例;年龄21～63岁,平均46.8岁;左侧10例,右侧8例.采用胫骨远端CT扫描,根据后踝、内踝的骨折特点制定AGH分型:Ⅰ型,后踝单一完整骨块,采用后外侧入路;Ⅱ型,后踝骨块沿矢状面劈裂,其中后踝两部分骨折为Ⅱa型,后踝粉碎性骨折为Ⅱb型,采用后外侧入路或后外侧联合后内侧入路;Ⅲ型,后踝骨折累及内踝前丘,其中前后丘未分离为Ⅲa型,前后丘分离为Ⅲb型,采用后外侧联合延长的后内侧入路.18例患者中,Ⅰ型5例,全部采用后外侧入路;Ⅱ型9例,其中Ⅱa型7例,Ⅱb型2例,4例Ⅱa型采用后外侧入路,3例Ⅱa型和2例Ⅱb型骨折采用后外侧联合后内侧入路;Ⅲ型4例,Ⅲa型和Ⅲb型各2例,采用后外侧联合延长的后内侧入路复位固定,其中Ⅲb型骨折由于前丘骨折块小,选择克氏针或细螺钉固定.术后以Burwell-Charnley放射学评价标准判定关节面复位质量,末次随访根据美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分系统对术后踝关节功能进行评估,采用视觉模拟评分(visual analogue scale,VAS)评估踝关节疼痛情况.结果 18例患者均获得随访,随访时间12～36个月,平均18.2个月;18例(100％)合并外踝骨折,13例(72.2％)合并踝关节后脱位,10例(55.6％)合并die-punch损伤;骨折块占胫骨远端关节面的平均面积31.4％(12％～46％).术后Burwell-Chamley分级:优10例,可7例,差1例;优良率为(55.56％,10/18).末次随访AOFAS评分为35～100分,平均82.5分,其中优7例、良7例、可3例、差1例,优良率为(77.8％,14/18);VAS评分0～5分,平均1.6分.结论 后pilon骨折是一种后踝骨折累及内踝的特殊类型骨折,基于CT扫描的AGH分型简单实用,对手术入路和固定方式的选择有较好的指导意义.“,”Objective To explore the role of AGH classification in operation for posterior pilon fractures.Methods Between January 2012 and June 2015,eighteen consecutive patients with posterior pilon fractures were managed in our trauma center,including 11 males and 7 females with the mean age of 46.8 years.There were 10 left ankles and 8 right ankles.Patient records were reviewed to decide operative approaches and procedures according to our proposed AGH classification system:type Ⅰ,a single complete fracture fragment;type Ⅱ,a posterior malleolus fracture with 2 subtypes;type Ⅲ,a posterior malleolus fracture associated with complete medial malleolus fracture with 2 subtypes.Surgery approach and fixation method depended on the type of fracture.All patients returned regularly to complete a physical examination,radiographs,and American Orthopedic Foot and Ankle Society (AOFAS) ankle/hind foot questionnaires and visual analogue scale (VAS).Results All patients were followed-up with a mean period of 18.2 months.According to the Burwell-Charnley radiological evaluation system,10 cases had obtained anatomic reduction,7 cases fair reduction and only 1 case poor reduction.The mean AOFAS sore was 82.5 and the mean VAS scores during weight-bearing walking was 1.6,respectively.Conclusion The posterior pilon fracture has unique features that fractures of the posterior malleolus extend into the posterior colliculus of the medial malleolus.The AGH classification system is worthy of popularization and application in clinics,and it is reliable and instructive in the treatment of posterior pilon fractures.