双钢板置入延期治疗C型Pilon骨折有效固定的比较

Effective fixation of double plates for delayed treatment of type C pilon fractures

背景:传统切开复位内固定治疗C型Pilon骨折,骨膜广泛剥离,软组织损伤大,固定后并发症多,关节功能恢复不理想;单纯微创技术或外固定结合有限内固定对复杂的C型Pilon骨折往往难于做到解剖复位。目的:分析前外侧"L"型锁定钢板结合内侧微创经皮接骨板置入延期治疗C型Pilon骨折的疗效及并发症情况,探讨治疗C型Pilon骨折的有效固定方法。方法:选择26例C型Pilon骨折患者,均采用前外侧"L"型锁定钢板结合内侧微创经皮接骨板置入治疗,置入钢板前后均行CT三维重建,固定前及固定后定期复查X射线片并随访,观察临床疗效及并发症情况,并采用Johner-Wruhs评分系统评估疗效。结果与结论:26例患者均获随访,平均随访16个月(9-24个月),1例延迟愈合(12个月),平均愈合时间15周(11-52周),无畸形愈合,并发症:浅层感染2例,均为金黄色葡萄球菌,予敞开伤口每日换药2周后愈合;无深层感染或骨髓炎;创伤性关节炎1例,予踝关节注射玻璃酸钠后好转;无皮瓣坏死;无肌腱激惹;无断钉或退钉现象;无神经损伤。按Johner-Wruhs评分系统评分:优11例,良12例,中3例,优良率88.5%。结果证实,前外侧"L"型锁定钢板结合内侧微创经皮接骨板置入延期治疗C型Pilon骨折,复位满意,坚强内固定,早期功能煅练,关节功能恢复良好,并发症少。

BACKGROUND： Traditional open reduction and internal fixation for type C pilon fractures is characterized extensive periosteal stripping, severe soft tissue injury, many postoperative complications, and unsatisfactory recovery of joint function. Minimally invasive technology or external fixation combined with limited internal fixation for type C pilon fractures are usually difficult to achieve anatomical reduction. OBJECTIVE： To explore the curative efficacy of anterolateral ＂L＂ type locking plate implantation combined with interior minimally invasive plate osteosynthesis in treatment of type C pilon fractures and postoperative complication occurrence in order to find out the efficient fixation method for type C pilon fractures. METHODS： Twenty-six patients with type C pilon fractures （15 males and 11 females, aged from 19 to 68 years, mean age of 39.2 years） were selected and subjected to anterolateral ＂L＂ type locking plate implantation combined with interior minimally invasive plate osteosynthesis. CT three-dimensional reconstruction was performed before and plate implantation. X-ray examination was carried out before and after fixation. All patients were followed up for observation of clinical efficacy and complications. The therapeutic effects were evaluated using the Johner-Wruhs scoring system. RESULTS AND CONCLUSION： The 26 patients were followed up for 16 months （from 9 to 24 months）. Delayed healing occurred in one case （after 12 months）, and the average healing time was 15 weeks （from 11 to 52 weeks）. There was no deformity healing. Two patients developed superficial incision infections of Staphylococcus aureus, healed by open wound and dressing change every day for 2 weeks. No deep infection or osteomyelitis was found. One patient was found to have traumatic arthritis of ankle joint, improved by the injection of sodium hyaluronate. There was no flap necrosis and tendon irritation, broken nail or screw withdrawal, and nerve injury. Johner-Wruhs scores were excellent in 11 cases, good in 12 cases, fair in 3 cases, with the total excellent to good rate of 88.5%. These findings indicate that anterolateral ＂L＂ type locking plate implantation combined with interior minimally invasive plate osteosynthesis for delayed treatment of type C pilon fractures can achieve satisfactory fracture reduction, rigid fixation, early functional exercise, less complications, and good recovery of joint function.