不同入路治疗胫骨远端后Pilon骨折近远期疗效比较

Comparison of short and long - term effects of different approaches in the treatment of distal tibia post-pilon fractures

目的 比较不同入路治疗胫骨远端后Pilon骨折近远期疗效.方法 选择29例胫骨远端后Pilon骨折患者作为研究对象进行回顾性分析,根据患者手术入路的不同分为A组（后内侧入路,n=16）和B组（前外侧入路,n=13）.比较两组住院时间、愈合时间、术后并发症、踝关节功能恢复优良率.结果 两组住院时间、骨愈合时间差异均无统计学意义（均P〉00.05）.两组术后总并发症发生率分别为6.3%、23.1%,差异无统计学意义（χ2=1.708,P〉00.05）,但A组切口拐角处部分坏死发生率为0.0%,显著低于B组的23.1%,差异有统计学意义（χ2=4.118,P〈0.05）.A组踝关节功能恢复优良率为93.8%,B组为76.9%,差异无统计学意义（χ2=1.708,P〉00.05）.结论 后侧入路可充分显露术野,复位效果佳,为踝穴的解剖复位提供可能,通过加强固定与术后早期踝关节功能康复训练可获得良好远期疗效,具有较大借鉴、参考价值,但需把握好适应证.

Objective To compare the short and long-term effects of different approaches in the treatment of distal tibia post-pilon fractures. Methods A retrospective analysis was carried out in 29 patients with distal tibia post-pilon fractures. They were divided into group A （ postmedial approach, n =16 ） and group B （ anterolateral approach,n=13） according to different operative approaches. The length of stay,healing time,postoperative complica-tions and excellent and good rate of hip functional recovery in the two groups were compared. Results There were no significant differences in length of stay and bone healing time between the two groups（all P〉00. 05）. There was no significant difference in the incidence rate of postoperative complication between the two groups（6. 3% vs. 23. 1%,χ2 =1. 708,P〉00. 05）,but the incidence rate of partial necrosis in incision corner of group A was significantly lower than that of group B（0. 0% vs. 23. 1%,χ2 =4. 118,P〈0. 05）. There was no significant difference in excellent and good rate of hip functional recovery between group A（93. 8%） and group B（76. 9%） （χ2 =1. 708,P〉0. 05）. Conclusion Posterior approach can fully expose the field of operation with good reduction effect,provide possible for anatomical reduction of ankle mortise,good long-term efficacy can be obtained through stable fixation and postopera-tive early hip functional rehabilitation training,can be used as great reference,but need to grasp the indications.