后外侧联合前内侧入路治疗复杂Pilon骨折的疗效及安全性分析

The efficacy and safety of posterior-lateral combined with anterior-medial approach in the treatment of complex Pilon fractures

目的探讨后外侧联合前内侧入路治疗复杂Pilon骨折的疗效及安全性。方法63例行择期内固定手术治疗的复杂Pilon骨折患者,其中后外侧联合前内侧入路术式32例(联合组),后外侧入路术式31例(后外侧组)。记录两组手术时间、术中出血量、术后1周疼痛程度[视觉模拟评分(VAS)]、术后住院时间、骨折愈合时间、完全负重时间等围术期相关指标,比较两组术后并发症发生情况、术后1个月骨代谢指标及术后12个月复位效果、踝关节功能差异。结果联合组手术时间、术后1周VAS评分、术后住院时间、骨折愈合时间、完全负重时间均低于后外侧组(P<0.05)。术后1个月时,联合组血清Ⅰ型前胶原N-端前肽(PⅠNP)、血清骨型碱性磷酸酶(BALP)、骨钙素(BGP)均高于后外侧组(P<0.05)。术后12个月时,联合组复位效果及踝关节功能优于后外侧组(P<0.05)。结论后外侧联合前内侧入路治疗复杂Pilon骨折效果显著,不仅能改善复位效果及踝关节功能,还能促进骨折愈合,也具有良好安全性,临床可将其作为主要治疗方法。

Objective To explore the efficacy and safety of posterior lateral combined with anteriormedial approach in the treatment of complex Pilon fractures.Methods A retrospective analysis was performed on 63 patients with complex Pilon fractures who underwent selective internal fixation surgery in our hospital.The patients included 32 cases of posterior lateral combined with anterior medial approach(combined group)and 31 cases of posterior lateral approach(posterior lateral group).The perioperative related inde xes such as operative time,intraoperative blood loss,pain degree at 1 week after operation(visual analogue scale,VAS),postoperative hospital stay,fracture healing time and complete weight bearing time were recorded in the two groups.The occurrence of postoperative complications and bone metabolism indexes after 1 month of operation,and reduction effects and ankle joint function after 12 months of operation were compared between the two groups.Results The operative time,VAS score after 1 week of operation,postoperative hospital stay,fracture healing time and complete weight bearing time in the combined group were lower than those in the posterior lateral group(P<0.05).After 1 month of operation,the levels of serum PINP,BALP and BGP in the combined group were higher than those in the posterior lateral group(P<0.05).After 12 months of operation,the reduction effects and ankle joint function in the combined group were significantly better than those in the posterior lateral group(P<0.05).Conclusion Posterior lateral combined with anteri or medial approach for complex Pilon fractures has significant effects.It can not only improve the reduction effects and ankle joint func tion,but also promote the fracture healing.