前外侧单切口手术入路在Pilon骨折合并腓骨骨折的效果及对骨折端愈合、踝关节功能的影响

Effect of Anterolateral Single Incision Approach in the Treatment of Pilon Fracture Combined with Fibula Fracture and Its Influence on Fracture Healing and Ankle Joint Function

目的:探讨前外侧单切口手术入路治疗Pilon骨折合并腓骨骨折的效果及对骨折端愈合、踝关节功能的影响。方法:选择2018年5月-2021年1月苏州市相城人民医院收治的Pilon骨折合并腓骨骨折患者68例为研究对象,按照随机数字表法分为对照组与观察组,各34例,对照组采取前内-后外侧双切口入路手术治疗,观察组采取前外侧单切口入路手术治疗,对两组治疗效果进行比较。结果:观察组治疗后复位良好率为97.06%,明显较对照组的82.35%高(P<0.05)。观察组骨性愈合时间、下床活动时间、负重行走时间均较对照组短(P<0.05)。术前,两组踝穴指标比较,差异均无统计学意义(P>0.05);术后1个月,两组踝穴高度、宽度、深度、冠状位角度及矢状位角度均低于术前,且观察组均低于对照组(P<0.05)。术前,两组美国足与踝关节协会踝与后足功能评分(AOFAS-AHS)评分比较,差异均无统计学意义(P>0.05);术后1年,两组AOFAS-AHS评分均高于术前,且观察组均高于对照组(P<0.05)。观察组并发症发生率为2.94%,较对照组的20.59%低(P<0.05)。结论:前外侧单切口入路手术治疗Pilon骨折合并腓骨骨折的效果满意,也能促进骨折端愈合,促进踝关节功能恢复,值得推广。

Objective:To investigate the effect of anterolateral single incision approach in the treatment of Pilon fracture combined with fibula fracture and its influence on fracture healing and ankle joint function.Method:A total of 68 patients with Pilon fracture combined with fibula fracture who treated in Suzhou Xiangcheng People’s Hospital from May 2018 to January 2021 were selected as the research objects.They were randomly divided into the control group and the observation group according to random number table method,34 cases in each group.The control group was treated with anteromedial-posterior-lateral double incision approach,and the observation group was treated with anterolateral single incision approach.The treatment effects of two groups were compared.Result:The good rate of reduction in the observation group after treatment was 97.06%,which was significantly higher than 82.35%in the control group(P<0.05).The time of bone healing,time of getting out of bed and time of weight-bearing walking in the observation group were shorter than those in the control group(P<0.05).Before operation,there were no significant differences in ankle point indexes between two groups(P>0.05);at 1 month after operation,the ankle height,ankle width,ankle depth,coronal angle and sagittal angle of two groups were lower than those of before operation,and those of the observation group were lower than those of the control group(P<0.05).Before operation,there were no significant differences in American Foot and Ankle Society’s ankle and hindfoot scale(AOFAS-AHS)scores between two groups(P>0.05);at 1 year after operation,the scores of AOFAS-AHS in two groups were higher than those before operation,those of the observation group were higher than those in the control group(P<0.05).The incidence of complications in the observation group was 2.94%,which was lower than 20.59%in the control group(P<0.05).Conclusion:The effect of anterolateral single incision approach in the treatment of Pilon fracture combined with fibula fracture is satisfactory,and it can also promote fracture healing and the recovery of ankle joint function,which is worthy of promotion.