两种方法治疗粉碎性Pilon骨折疗效分析

Efficacy analysis of two types of fixation methods for treatment of comminuted Pilon fractures

目的对比前外侧入路L型锁定钢板与内侧入路普通钢板治疗粉碎性Pilon骨折的临床疗效。方法手术治疗45例胫骨远端粉碎性Pilon骨折患者,26例行前外侧入路L型锁定钢板固定(锁定钢板组),19例行内侧入路普通钢板固定(普通钢板组)。比较两组术后临床疗效及并发症情况。结果锁定钢板组的手术时间、术中出血量和术后骨折愈合时间明显低于普通钢板组,差异均有统计学意义(P<0.05)。45例均获得随访,时间12~40个月。锁定钢板组皮缘坏死1例,骨折延迟愈合1例;Mazur评分:优10例,良15例,差1例;末次随访时AOFAS踝-后足评分80~96(90±6)分;踝关节活动度:跖屈30°~44°(37°±4°),背伸15°~24°(19°±3°)。普通钢板组骨不连1例,伤口感染1例,关节面塌陷2例;Mazur评分:优7例,良10例,可1例,差1例;末次随访时AOFAS踝-后足评分为76~93(89±7)分;踝关节活动度:跖屈24°~44°(36°±5°),背伸13°~20°(17°±2°)。锁定钢板组Mazur功能评分、AOFAS踝-后足评分均优于普通钢板组,差异均有统计学意义(P<0.05)。锁定钢板组并发症发生情况优于普通钢板组,差异有统计学意义(P<0.05)。踝关节活动度两组比较差异无统计学意义(P>0.05)。结论与内侧入路普通钢板比较,前外侧入路L型锁定钢板治疗粉碎性Pilon骨折术中出血量少,手术时间和术后骨折愈合时间短,术后稳定性强,并发症少。

Objective To explore the clinical effects of comminuted Pilon fractures treated by L-anatomical locking plate via anterolateral incision and common anatomical plate via medial approach. Methods The 45 consecutive comminuted Pilon fractures were surgically treated. The L-anatomical locking plate group（ The locking plate group）including 26 patients were treated via anterolateral incision and the common anatomical plate group（ The common plate group） including 19 patients were treated via medial approach. The clinical effects and the complications of two groups were compared. Results The operation time,blood loss and fracture healing time of the locking plate group were obviously lower than that in the common plate group,there were significant difference between them（ P〈0. 05）.All patients were followed up for 12 - 40 months. In the locking plate group： there were 1 case of local skin necrosis,and 1 case of delayed osseous union; according to Mazur evaluation criteria： 10 cases were excellent,15 cases good,1 case poor; at the final follow-up,the AOFAS scores ranged from 80 - 96（ 90 ± 6）; the ankle plantar flexion ranged from 30° - 44°（ 37° ± 4°）; the ankle dorsal extension ranged from 15° - 24°（ 19° ± 3°）. In the common plate group： there were 1 case bone nonunion,1 case wound infection,2 cases collapse of articular surface; according to Mazur evaluation criteria： 7 cases were excellent,10 cases good,1 case fair,1 case poor; at the final follow-up,the AOFAS scores ranged from 76 - 93（ 89 ± 7）; the ankle plantar flexion ranged from 24° - 44°（ 36° ± 5°）; the ankle dorsal extension ranged from 13° - 20°（ 17° ± 2°）. Comparing two groups,the complications,the Mazur functional scores and the AOFAS scores of the locking plate group were more better than that in common plate group,there were significant difference between them（ P〈0. 05）. There was no significant difference between the range of motion of ankle（ P〈0. 05）. Conclusions Compared with common anatomical plate via medial approach,L-anatomical locking plate via anterolateral incision for comminuted tibial Pilon fractures is more effective.