不同钢板内固定治疗Ruedi-Allgower Ⅱ、Ⅲ型闭合性胫骨Pilon骨折的临床疗效比较研究

Research on Clinical Effect Comparison of Treatment for Ruedi-Allgower Ⅱ,Ⅲ Type Closed Tibial Pilon Fracture in Different Plate Internal Fixations

目的研究分析不同钢板内固定治疗Ruedi-AllgowerⅡ、Ⅲ型闭合性胫骨Pilon骨折的临床疗效及不良反应情况。方法选取2010年1月-2015年1月哈尔滨医科大学附属第一医院骨外科收治闭合性胫骨Pilon骨折患者54例。治疗医师根据患者手术内固定物的不同将所有患者分为两组，A组行LCP内固定治疗，B组行解剖钢板内固定治疗，观察两组患者手术时间、术中出血量、住院时间、下地患肢无负重练习时间、骨折愈合时间、末次随访临床效果评定及不良反应情况。结果治疗医师通过门诊复查对两组患者行8-16个月随访，平均随访时间11．35±2．25个月。A组患者的手术平均时间、骨折愈合平均时间显著少于B组，差异具有统计学意义（P〈0．05）；两组的术中平均出血量、住院平均时间、下地患肢无负重练习平均时间比较差异无统计学意义（P〉0．05）；两组患者术后末次随访AOFAS踝-后足评分结果显示，A组术后末次随访AOFAS踝-后足评分优良率略高于B组，差异具有统计学意义（P〈0．05）；A组不良反应发生率显著低于B组，差异具有统计学意义（P〈0．05）。两组术后末次随访的骨折影像学复位评估，A组23例解剖复位，3例部分复位，1例复位较差；B组22例解剖复位，3例部分复位，2例复位较差，两组的各种复位患者比率差异无统计学意义（P〉0．05）。结论锁定钢板内固定治疗Ruedi-AllgowerⅡ、Ⅲ型闭合性胫骨Pilon骨折临床疗效更佳，在降低手术创伤的同时，关节面恢复、骨折端稳固固定更好，术后不良反应发生率更低，适合临床推广应用。

Objective To analyze the clinical effect and adverse reactions of treatment for Ruedi - Allgower Ⅱ , Ⅲ type closed tibial Pilon fracture in different plate internal fixations. Methods We selected/54 patients with closed tihial Pilon fracture treated in bone sur- gery of The First Affiliated Hospital of Herbin Medical University from Jan. 2010 to Jan. 2015. Therapist divided the patients into two groups based on differences of internal fixations. Team A will make LCP internal fixation treatment and team B will make anatomical plate internal fixation, we observed/operation time, blood loss during operation, hospitalization time, no weight - bearing exercising time for ambulation limb, fracture healing time, clinical effects assessment of last follow - up and adverse reactions of two groups of patients. Re- suits Therapist made follow - ups to two groups of patients by 8 - 16 months through outpatient review, 11.35 ± 2.25 months on aver- age. The average time of team A was obvious less than team B in average operation and fracture healing and the differences have statistical significance （ P 〈 O. 05 ） ; while there was no obvious differences in average blood loss during operation, hospitalization time and no weight - bearing exercising time for ambulation limb between the two teams, so there was no statistical significance （P 〉 0.05 ）. Results of ankle joint AOFAS score in last follow - up after operation among two groups of patients showed/that the excellent rate of recovery in last follow - up after operation of team A was higher than team B and differences had statistical significance （P 〈 0.05）. The adverse reaction rate of team A was obviously lower than team A and differences had statistical significance （P 〈 0.05）. In the fracture imaging reset assessment of last follow - up after operation of the two groups, there were 23 anatomic reductions, 3 partial reductions and 1 poor reduction in team A. There were 22 anatomic reductions, 3 partial reductions and 2 poor reductions in team B. There was no obvious differences in ratio of each reduction in the two groups and there is no statistical significance （ P 〉 O. 05 ）. Conclusion Locking plate internal fixation treatment for Ruedi - Allgower Ⅱ , Ⅲ type closed tibial Pilon fracture has better clinical effect, which can decreases surgical trauma, meanwhile, has better performance in articular surface restoration and fracture stabilization and fixation, adverse reaction rate after operation is lower and suitable to promote widely in clinical application.