临时外固定支架结合支撑钢板治疗伴有Tscherne Ⅱ度损伤后Pilon骨折临床观察

Effect observation on posterior Pilon fracture with Tscherne Ⅱ degree ingury after temporary external fixation combined with buttress plate treatment

目的后Pilon骨折常伴有软组织损伤及粉碎骨折,软组织受累和粉碎性骨折都对治疗提出了挑战。本研究探讨临时外固定支架结合支撑钢板治疗伴有TscherneⅡ度损伤的后Pilon骨折临床疗效,以寻求最佳手术方案。方法选取2015-01-01-2017-12-31南华大学附属第二医院收治的伴有TscherneⅡ度损伤的后Pilon骨折10例。通过视觉模拟评分(visual analogue scale,VAS)及美国骨科足踝学会(American Orthopedic Foot and Ankle Society,AOFAS)评分标准评估临床疗效。观察患者术后并发症及骨折愈合情况。结果患者术前VAS评分为(8.70±0.95)分,外固定术后为(2.80±0.79)分,差异有统计学意义,t=16.954,P<0.001。终末休息时VAS评分为(0.20±0.42)分,活动时为(0.70±0.67)分,负重状态时为(1.80±0.63)分。患者终末AOFAS评分为(86.60±5.34)分,优5例,良5例。术后钉道均无感染,伤口均愈合,切口无浅表感染及深部感染发生。所有病例最后一次随访时骨折已完全愈合,无内固定失效情况。结论临时外固定结合支撑钢板对治疗伴有TscherneⅡ度损伤的后pilon骨折临床疗效较好,有效减少并发症。

OBJECTIVE Posterior pilon fractures are often accompanied by soft tissue injuries and comminuted fractures.Both soft tissue involvement and comminuted fractures pose challenges to treatment.This study explores the clinical efficacy of temporary external fixation combined with support plate in the treatment of posterior Pilon fractures with TscherneⅡdegree injury in order to find the best surgical plan.METHODS A total of 10 cases of posterior Pilon fractures with TscherneⅡinjury admitted to the Second Affiliated Hospital of Nanhua University from January 01,2015 to December 31,2017 were selected.The clinical efficacy was evaluated by visual analogue scale(VAS)and American Orthopedic Foot and Ankle Society(AOFAS)scoring criteria.Observe the postoperative complications and fracture healing of the patients.RESULTS The VAS score of the patient was(8.70±0.95)before operation and(2.80±0.79)after external fixation.The difference was statistically significant,t=16.954,P<0.001.The VAS score was(0.20±0.42)at the end of the break,(0.70±0.67)at the time of activity,and(1.80±0.63)at the weight-bearing state.The final AOFAS score of the patient was(86.60±5.34),5 cases were excellent and 5 cases were good.There was no infection in the nail tract after the operation,and the wounds healed.No superficial infection and deep infection occurred in the incision.At the last follow-up of all cases,the fracture had healed completely and there was no failure of internal fixation.CONCLUSION Temporary external fixation combined with support plate had a good clinical effect on the treatment of posterior pilon fractures with TscherneⅡdegree injury,and effectively reduced complications.