不同手术固定方式治疗AO-C3型Pilon骨折的临床对照研究

Comparative study of Different Surgical Methods in Treatment of Type AO-C3 Pilon Fracture

目的探讨不同手术固定方式治疗AO-C3型Pilon骨折的临床价值。方法回顾性分析2008年1月—2013年1月收治的60例AO-C3型Pilon骨折患者的临床资料,按手术方法分为A组16例、B组20例、C组24例。A组采用切开复位胫骨远端解剖钢板内固定术,B组采用微创经皮锁定钢板内固定术,C组采用有限内固定结合外固定术。观察3组临床疗效、骨折重建质量、早期及远期并发症发生情况。结果 3组优良率、解剖复位率、远期并发症发生率比较差异无统计学意义(P>0.05);A组早期并发症发生率高于B、C组(P<0.05),B、C组比较差异无统计学意义(P>0.05)。结论 3种手术方案各具优势,但微创经皮锁定钢板内固定手术和有限内固定结合外固定手术治疗方案能够有效降低AO-C3型Pilon骨折患者早期的并发症,对于大范围感染、骨折区软组织缺损严重者选取有限内固定结合外固定术具有一定优势。

Objective To study clinical value of different fixation methods in treatment of type AO-C3 Pilon fracture. Methods Clinic data of 60 patients with type AO-C3 Pilon fracture admitted during January 2008 and January 2013 was retrospectively analyzed, and the patients were divided into group A （n = 16）, B （n =20） and C （n =24） according to surgical methods. Group A received open reduction of distal tibia anatomical plate internal fixation ; group B received minimal invasive of percutaneous locking plate internal fixation; group C received limited internal fixation combined with external fixation. Clinical effect, quality of fracture reconstruction and early and long-term complication condi- tions were observed in three groups. Results The differences of good rate, anatomic reduction rate and long-term incidence rate of complication showed no statistic significances among three groups （P〉0. 05 ）. The early-term incidence rate of complication in group A was higher than those in group B and C （P〈0.05）, but there was no significant difference in the rate between group B and C （P〉0. 05）. Conclusion The three fixation methods have their own advantages. Both minimal invasive of percutaneous locking plate internal fixation and limited internal fixation combined with external fixation can effectively reduce early-term incidence rate of complications of patients with type AO-C3 Pilon fracture, and limited internal fixation combined with external fixation has a certain advantage for patient with wide-bound infection and severe soft tissue loss in fracture area.