前外侧入路联合内侧MIPPO治疗AO/OTA C型Pilon骨折的临床疗效果

Clinical effect of anterior lateral approach combined with medial MIPPO in the treatment of AO/OTA C-type Pilon fracture

目的探讨前外侧入路联合内侧微创经皮钢板内固定(MIPPO)治疗AO/OTA C型Pilon骨折的临床效果。方法回顾性分析2016年6月—2017年6月天门市第一人民医院骨科应用前外侧入路联合内侧MIPPO治疗的AO/OTA C型Pilon骨折患者51例,男性42例,女性9例;年龄19~72岁,平均46.8岁;摔伤32例,道路交通伤19例。分析骨折愈合时间、VAS评分、术后并发症(伤口感染、螺钉松动和神经血管损伤等)发生率、踝关节的运动范围(ROM)及美国足踝外科协会(AOFAS)踝-后足功能评分。结果患者术后随访14~30个月,平均22.6个月。骨折全部愈合,对位对线良好,平均愈合时间(10.3±4.0)个月。VAS和AOFAS评分术后12个月[(2.1±0.5)分、(82.8±15.3)分]与末次随访[(2.0±0.6)分、(81.9±18.0)分]比较差异无统计学意义(P>0.05)。末次随访时,患肢踝关节背屈ROM为(13.0±2.2)°,跖屈ROM为(38.3±3.6)°。随访期间,未发现内固定失效、螺钉松动等并发症,2例患者术后出现伤口感染致延期愈合,予伤口换药后二期愈合。结论对于AO/OTA C型Pilon骨折而言,选择前外侧入路联合内侧MIPPO,不仅临床疗效满意,且术后并发症发生率低。

Objective To investigate the clinical effect of anterolateral approach combined with medial minimally invasive percutaneous plate osteosynthesis(MIPPO)in the treatment of AO/OTA type C Pilon fractures.Methods A retrospective analysis was conducted in 51 patients with AO/OTA type C Pilon fractures treated with anterolateral approach combined with medial MIPPO in the Department of Orthopedics,The First People’s Hospital of Tianmen City from Jun.2016 to Jun.2017.There were 42 males and 9 females,with an average age of 46.8 years(range,19-72 years);there were 32 cases of falling injuries and 19 cases of traffic accident injuries.The incidence of postoperative complications(wound infection,screw loosening,neurovascular injury,etc.),fracture union time,visual analog scale(VAS),range of motion(ROM)of the ankle joint,and American Association of Foot and Ankle Surgery(AOFAS)ankle hindfoot score were analyzed.Results The patients were followed up for 14-30 months,with an average of 22.6 months.All fractures healed with good alignment,and the average healing time was(10.3±4.0)months.There was no significant difference in VAS and AOFAS scores between 12 months after operation(2.1±0.5,82.8±15.3)and at the last follow-up(2.0±0.6,81.9±18.0),P>0.05.At the last follow-up,the ROM of ankle dorsiflexion of the affected limb was(13.0±2.2)°,and the ROM of plantar flexion was(38.3±3.6)°.During the follow-up period,no complication such as failure of internal fixation or screw loosening was found.Two patients developed into infection and delayed healing after surgery,and finally achieved secondary wound healing after change of dressing.Conclusion For AO/OTA C-type Pilon fractures,the anterolateral approach combined with medial MIPPO not only has a satisfactory clinical effect,but also has a low incidence of postoperative complications.