踝前区弧形切口联合MIPO疗法对Pilon骨折的治疗分析

Analysis of the Treatment of Pilon Fractures by Arc Incision in Anterior Ankle Area Combined with MIPO Therapy

目的探讨对Pilon骨折患者采用踝前区弧形切口+MIPO疗法进行治疗后的临床效果。方法选取2018年1月—2020年12月收治的68例Pilon患者为研究对象,随机分为常规组(选择切开内固定法治疗)和研究组(选择踝前区弧形切口+MIPO疗法治疗),各34例;比较两组患者平均失血量、平均手术时间、患侧与健侧差值(冠状位角度差、宽度差、矢状位角度差)、踝关节功能优良率以及骨折解剖复位率。结果研究组平均失血量(50.59±2.71)mL、平均手术时间(38.12±3.09)min优于常规组平均失血量(59.26±2.65)mL、平均手术时间(47.26±3.29)min,差异有统计学意义(t=13.337、11.807,P<0.05);治疗前,研究组冠状位角度差(1.85±0.35)°、宽度差(0.69±0.09)mm、矢状位角度差(0.99±0.25)°同常规组冠状位角度差(1.86±0.39)°、宽度差(0.72±0.12)mm、矢状位角度差(0.97±0.27)°比较,差异无统计学意义(t=0.111、1.166、0.316,P>0.05);治疗后,研究组冠状位角度差(0.37±0.06)°、宽度差(0.25±0.04)mm、矢状位角度差(0.26±0.05)°均低于常规组冠状位角度差(0.79±0.09)°、宽度差(0.35±0.05)mm、矢状位角度差(0.66±0.09)°,差异有统计学意义(t=22.641、9.106、22.654,P<0.05);研究组踝关节功能优良率(97.06%)高于常规组(76.47%),差异有统计学意义(χ^(2)=4.610,P<0.05);研究组骨折解剖复位率(100.00%)高于常规组(79.41%),差异有统计学意义(χ^(2)=5.733,P<0.05)。结论踝前区弧形切口+MIPO疗法有效应用后,可减少患者失血量,缩短手术时间,将降低患侧与健侧差值,有效提高踝关节功能优良率以及骨折解剖复位率,最终促进Pilon骨折患者预后水平提升。

Objective To investigate the clinical effect of treating patients with Pilon fractures with anterior ankle incision and MIPO therapy.Methods A total of 68 patients with Pilon who were admitted from January 2018 to December 2020 were selected as the research study.They were randomly divided into conventional group(choose incision and internal fixation therapy)and study group(choose anterior ankle incision arc incision+MIPO therapy),34 cases in each.The average blood loss,average operation time,the difference between the affected side and the healthy side(coronal angle difference,width difference,sagittal angle difference),the excellent and good rate of ankle function and the rate of fracture anatomical reduction were compared between the two groups.Results The average blood loss in the study group was(50.59±2.71)mL,and the average operation time(38.12±3.09)min was better than that the average blood loss(59.26±2.65)mL,and the average operation time(47.26±3.29)min in the conventional group,and the difference was statistically significant(t=13.337,11.807,P<0.05);before treatment,the coronal angle difference(1.85±0.35)°,the width difference(0.69±0.09)mm,the sagittal angle difference(0.99±0.25)°in the study group compared with the conventional group in coronal angle difference(1.86±0.39)°,width difference(0.72±0.12)mm,sagittal angle difference(0.97±0.27)°,the difference was not statistically significant(t=0.111,1.166,0.316,P>0.05);after treatment,the coronal angle difference(0.37±0.06)°,the width difference(0.25±0.04)mm,and the sagittal angle difference(0.26±0.05)°in the study group were lower than those in the conventional group’s angle difference(0.79±0.09)°,width difference(0.35±0.05)mm,sagittal angle difference(0.66±0.09)°,the difference was statistically significant(t=22.641,9.106,22.654,P<0.05);the excellent and good rate of ankle joint function in the group(97.06%)was higher than that in the routine group(76.47%),and the difference was statistically significant(χ^(2)=4.610,P<0.05).Anatomic reduction rate of fracture in study group(100.00%)was higher than that in conventional group(79.41%),the difference was statistically significant(χ^(2)=5.733,P<0.05).Conclusion After the effective application of the anterior ankle incision+MIPO therapy,the blood loss of the patient can be reduced,the operation time can be shortened,the difference between the affected side and the healthy side of the patient can be reduced,and the excellent and good rate of ankle joint function and fracture anatomical reduction rate can be effectively improved.Ultimately,it will improve the prognosis of patients with Pilon fractures.