改良前内侧入路与联合入路治疗Rüedi-Allg wer Ⅲ型Pilon骨折的疗效比较

Modified anteromedial approach versus conventional combined approach in the treatment of Rüedi-Allg wer typeⅢPilon fractures

目的对比改良前内侧手术入路与联合入路治疗Rüedi-Allg werⅢ型Pilon骨折的临床疗效。方法回顾性分析2015年1月—2019年1月汉中市中心医院骨科收治的73例Rüedi-Allg werⅢ型Pilon骨折患者临床资料,男性51例,女性22例;年龄23~76岁,平均49.5岁;道路交通伤23例,高处坠落伤30例,扭伤16例,砸伤4例。按手术入路分为两组:踝关节改良前内侧入路38例为改良组,前内侧联合后外侧入路35例为传统组。记录并比较两组患者术中失血量、手术时间、骨折愈合时间及末次随访时踝关节美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分、术后并发症的发生情况,应用Burwell-Charnley影像学评价骨折复位质量。结果改良组与传统组比较,术中失血量少[(99.9±53.3)mL vs.(131.7±55.1)mL]、手术时间及骨折愈合时间短[(134.4±26.1)min vs.(146.8±24.4)min、(15.6±3.0)周vs.(19.7±5.4)周],差异均有统计学意义(P<0.05)。两组骨折复位质量及AOFAS评分比较差异均无统计学意义(P>0.05)。改良组1例发生浅表切口皮缘坏死;传统组4例浅表切口皮缘坏死,1例浅表切口感染,3例骨折延迟愈合,两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论改良前内侧入路与联合入路治疗Rüedi-Allg werⅢ型Pilon骨折均可取得良好效果,但踝关节改良前内侧入路治疗累及三柱的Rüedi-Allg werⅢ型Pilon骨折可减少术中失血量少,缩短手术时间,并发症少,临床疗效满意。

Objective To compare the clinical efficacy between modified anteromedial approach and conventional combined approach in the treatment of Rüedi-Allgower typeⅢPilon fractures.Methods Clinical data of 73 patients with Rüedi-Allgower typeⅢPilon fractures admitted at the department of traumatic orthopaedics of Hanzhong Central Hospital from Jan.2015 to Jan.2019 were retrospectively analyzed,including 51 males and 22 females,with an average age of 49.5 years(range,23-76 years).There were 23 cases of road traffic injuries,30 falling injuries,16 sprain injuries and 4 smashing injuries.According to the surgical approaches,patients were divided into modified group with the modified anteromedial approach applied in 38 cases,and conventional group with the conventional combined approach applied in 35 cases.The parameters of intraoperative blood loss,operation time,fracture healing time,the American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot scale score,and incidence of postoperative complications were collected.Burwell-Charnley criteria was adopted to judge the quality of fracture reduction radiologically.Results Compared with the conventional group,the modified group had less intraoperative blood loss[(99.9±53.3)mL vs.(131.7±55.1)mL],shorter operation time[(134.4±26.1)min vs.(146.8±24.4)min],quicker fracture healing[(15.6±3.0)weeks vs.(19.7±5.4)weeks](all P<0.05).While the radiological reduction quality and AOFAS score revealed no significant difference(P>0.05).In the modified group,1 case had skin necrosis of the superficial incision;while in the combined approach group,4 cases had skin necrosis and another 1 had infection of the superficial incision,and 3 more cases had delayed fracture healing.But the incidence of postoperative complications revealed no significant difference between two groups(P>0.05).Conclusion Both modified anteromedial approach and conventional combined approach can achieve a good therapeutic effect in managing Rüedi-Allgower type Ⅲ Pilon fractures involving three columns.However,the former is superior in reducing intraoperative blood loss,shortening operation time,and decreasing complications,thus to ensure a more satisfactory clinical effect.