Objective: 

To quantify soft tissue perfusion changes in pilon fractures during staged treatment using laser-assisted indocyanine green angiography (LA-ICGA).

Setting: 

Level 1 trauma center.

Design: 

Prospective cohort study.

Patients/Participants: 

Twelve patients with 12 pilon fractures participated in the study. Seven patients had OTA/AO classification of 43-C3, 3 had 43-C2, and 2 had 43-B2.

Main Outcome Measures: 

LA-ICGA was performed with the SPY fluorescence imaging platform. Analysis via ImageJ was used to generate a fractional area of perfusion (FAP) based on fluorescent intensity to objectively quantify soft tissue perfusion. Anterior, medial, and lateral measurements were performed at the time of initial external fixation (EF) application and then at the time of definitive fixation.

Results: 

FAP within the region of interest was on average 64% medially, 61% laterally, and 62% anteriorly immediately before EF placement. Immediately before definitive open reduction internal fixation, fractional region of interest perfusion was on average 86% medially, 87% laterally, and 86% anteriorly. FAP increased on average 24% medially (P = 0.0004), 26% laterally (P = 0.001), and 19% anteriorly (P = 0.002) from the time of initial EF to the time of definitive open reduction and internal fixation.

Conclusions: 

Quantitative improvement in soft tissue perfusion was identified through the course of staged surgical management in pilon fractures. LA-ICGA potentially may be used to determine appropriate timing for definitive surgical intervention based on the readiness of the soft tissue envelope. Ultimately, these findings may influence clinical outcomes with respect to choice of surgical approach, soft tissue management, surgical timing, and wound healing.

Level of Evidence: 

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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激光辅助吲哚菁绿血管造影能否用于量化 Pilon 骨折分期固定期间的灌注变化？试点研究

客观的： 

使用激光辅助吲哚菁绿血管造影术 (LA-ICGA) 量化分期治疗期间 pilon 骨折的软组织灌注变化。

环境： 

一级创伤中心。

设计： 

前瞻性队列研究。

患者/参与者： 

12 名患有 12 处 pilon 骨折的患者参与了这项研究。7 名患者的 OTA/AO 分类为 43-C3，3 名患者为 43-C2，2 名患者为 43-B2。

主要观察指标： 

LA-ICGA 是用 SPY 荧光成像平台进行的。通过 ImageJ 进行的分析用于根据荧光强度生成灌注面积分数 (FAP)，以客观地量化软组织灌注。前部、内侧和外侧测量在初始外固定 (EF) 应用时进行，然后在最终固定时进行。

结果： 

在 EF 放置之前，感兴趣区域内的 FAP 平均为内侧 64%、外侧 61% 和前方 62%。在确定性切开复位内固定术之前，感兴趣区域灌注分数平均为内侧 86%、外侧 87% 和前方 86%。从初始 EF 到确定性切开复位内固定期间， FAP 平均内侧增加 24% ( P = 0.0004)，外侧增加 26% ( P = 0.001)，前方增加 19% ( P = 0.002) 。

结论： 

通过 pilon 骨折的分期手术治疗过程，确定了软组织灌注的定量改善。LA-ICGA 可能用于根据软组织包膜的准备情况确定最终手术干预的适当时机。最终，这些发现可能会影响手术入路选择、软组织管理、手术时机和伤口愈合方面的临床结果。

证据等级： 

诊断级别 III。有关证据等级的完整描述，请参阅作者须知。