目的 探讨改良前内侧入路保留伸肌上支持带与传统前内侧联合后外侧入路，治疗Rüedi-Allg?wer Ⅲ型Pilon骨折的临床疗效。 方法 本研究选取2020年1月至2022年1月期间的56例在遵义市第一人民医院治疗Rüedi-Allg?wer Ⅲ型Pilon骨折的患者，56例患者均满足纳排除标准，观察组27例，对照组29例。两组均为Pilon骨折切开复位内固定术。观察组采用改良前内侧入路保留伸肌上支持带。对照组采用传统前内侧联合后外侧入路切断伸肌上支持带。对比观察组和对照组患者的一般临床资料、手术时间、术中失血量、术后引流量、骨折复位质量、早期疼痛VAS评分、并发症及踝关功能等评估，分析比较两种手术方式的早期临床疗效。 结果 观察组与对照组患者的年龄、性别、体质量指数（BMI）、受伤机制及受伤至手术时间等相比较，差异无统计学意义（P > 0.05）。观察组：手术时间（115.92 ± 12.23）min，术中失血量（129.25 ± 16.15）mL，术后引流量（82.44 ± 25.57）mL，骨折愈合时间（17.89 ± 2.39）周；对照组：手术时间（172.75 ± 15.09）min，术中失血量（177.24 ± 24.36）mL，术后引流量为（115.06 ± 21.95）mL，骨折愈合时间（19.93 ± 3.75）周。观察组手术时间、骨折愈合时间均小于对照组（P < 0.05），观察组术中失血量、术后引流量均少于对照组，差异有统计学意义（P < 0.05）。复位优良率观察组96.29%，对照组93.10%，两组患者骨折解剖复位情况比较，差异无统计学意义（P > 0.05）。观察组术后3 d、术后1周、4周疼痛VAS评分均低于对照组（P < 0.05）。术后两组患者均获得至少12个月的随访，观察组术后并发症发生率低于对照组（P < 0.05）。观察组术后3、6、12个月的AOFAS评分均比对照组高（P < 0.05）。 结论 改良前内侧入路保留伸肌上支持带，相对于传统联合手术入路切断伸肌上支持带，治疗Rüedi-Allg?wer Ⅲ型Pilon骨折，具有手术时间短、术中失血量少、术后并发症少等优势。改良前内侧入路保留伸肌上支持带组踝关节功能恢复优于传统联合手术入路切断伸肌上支持带组。

Objective To explore the clinical efficacy of modified anteromedia approach with superior extensor retinaculars and traditional anteromedia combined with posterolateral approach in the treatment of Rüedi-Allg?wer type Ⅲ Pilon fractures. Methods In this study selected 56 patients with Rüedi-Allg?wer type Ⅲ Pilon fractures treated in our hospital from January 2020 to January 2022， all of whom met the inclusion and exclusion criteria， 27 in the experimental group and 29 in the control group. Both groups underwent open reduction and internal fixation of Pilon fractures. The experimental group used a modified anteromedial approach to preserve the supraspinatus， while the control group used a traditional anteromedial combined with posterolateral approach to cut off the supraspinatus. The general clinical data， operation time， intraoperative blood loss， postoperative drainage volume， fracture reduction quality， early pain VAS score， complications and ankle function evaluation of the experimental group and the control group were compared in detail， and the early clinical efficacy of the two surgical methods was analyzed and compared. Results There were no significant differences in age， gender， body mass index （BMI）， complications， injury mechanism and the time from admission to operation between the experimental group and the control group （P > 0.05）. Experimental group： operation time （115.92 ± 12.23）min， intraoperative blood loss（129.25 ± 16.15）mL， postoperative drainage volume （82.44 ± 25.57）mL， fracture healing time （17.89 ± 2.39）w；Control group： operation time （172.75 ± 15.09）min， intraoperative blood loss （177.24 ± 14.36）mL， postoperative drainage volume（115.06 ± 21.95）mL， fracture healing time（19.93 ± 3.75）w. The operative time and fracture healing time of the experimental group were less than those of the control group（P < 0.05）， and the intraoperative blood loss and postoperative drainage volume of the experimental group were less than those of the control group， the difference was statistically significant（P < 0.05）. The Buewell-Charnley fracture reduction radiological evaluation criteria were used to evaluate the fracture reduction， and the rate of good reduction was 96.29% in the experimental group and 93.10% in the control group. There was no statistical significance in the anatomical reduction between the two groups （P > 0.05）. Visual analog scale （VAS） was used to evaluate postoperative pain， and pain VAS scores of the experimental group were lower than those of the control group at 3 days， 1 week and 4 weeks after surgery （P <0.05）. Both groups were followed up for at least 12 months after surgery， and the incidence of postoperative complications in the experimental group was lower than that in the control group（P < 0.05）. The AOFAS score of the experimental group was higher than that of the control group at 3 months， 6 months and 12 months after surgery （P < 0.05）. Conclusion Improvement on the medial approach retains the superior extensor retinaculum， relative to the combined surgical approach to cut off the superior extensor retinaculum treatment Rüedi-Allg?wer Ⅲ Pilon fractures， with shorter operation time， less intraoperative blood loss， less postoperative complications and other advantages. The functional recovery of the ankle joint in the modified anteromedial approach preserving the superior extensor retinaculum was better than that in the combined approach cutting the superior extensor retinaculum.