三叶草钢板与解剖钢板固定治疗Pilon骨折的疗效分析

Cloverleaf plates and distal tibial anatomical plates in treatment of Pilon fracture:an analysis of outcome

目的分析应用三叶草钢板与解剖钢板固定治疗Pilon骨折的疗效。方法回顾性分析36例切开复位钢板内固定治疗的Pilon骨折患者资料,其中Ruedi-AllgowerⅡ型20例,Ⅲ型16例。15例主要为矢状面骨折,复位后于胫骨前内侧应用三叶草型钢板内固定(三叶草钢板组);21例主要为冠状面骨折,于胫骨远端应用解剖钢板固定(解剖钢板组)。随访皮肤和骨折愈合情况,采用Mazur评分系统评定踝关节功能并进行组问比较。结果随访时间为6～70个月,中位时间为46个月,骨折全部愈合。根据Mazur评分系统,三叶草钢板组踝关节功能评定优5例,良9例,可1例,优良率为93.3%;解剖钢板组优8例,良10例,可2例,差1例,优良率为85.7%;两组优良率的差异无统计学意义(P>0.05);总体优良率为88.9%。无切口感染和皮肤坏死病例。结论三叶草钢板和解剖钢板固定治疗Pilon骨折均能获得良好疗效,但应根据骨折类型进行选择。

Objective To assess the effectiveness of distal tibial anatomical plate and cloverleaf plate in the treatment of Pilon fractures. Methods The clinical data of 36 patients with Pilon fractures, who were treated by cloverleaf or distal anatomical plates, were retrospectively analyzed. According to Ruedi-Allgower classification, there were 20 type Ⅱ fractures and 16 type Ⅲ fractures. Cloverleaf plates（cloverleaf plate group） were used in 15 patients with sagittal fracture line; distal tibial anatomical plates（anatomical plate group） were used in 21 patients with coronal fractures lines. Healing of the wounds and fractures was recorded and the function of ankles was assessed with Mazur ankle scoring system. Results Fracture union was achieved in all patients after a mean followup of 46 months（ranging from 6 to 70 months）. According to Mazur ankle scoring system, in cloverleaf plate group the ankle function was excellent in 5 cases, good in 9 cases, and moderate in 1 case, with a satisfactory rate of 93.3 % ; and in distal tibial anatomical plate group the ankle function was excellent in 8 cases, good in 10, moderate in 2, and poor in 1, with the satisfactory rate being 85.7 %. There was no significant difference in the satisfactory rates between the 2 groups（P〉0.05）. The total satisfactory rate was 88.9%. There was no infection or skin necrosis in this series. Conclusion Open reduction and internal fixation with either cloverleaf or distal tibial anatomical plate can achieve satisfactory outcomes in treating Pilon fractures ; the plate should be selected according to the type of the fracture line.