两种锁定钢板治疗RüediⅢ型Pilon骨折的疗效比较

Comparison on the Clinical Efficacy of Two Locking Plates in the Treatment of RüediⅢPilon Fractures

目的比较万向锁定加压接骨板(variable angle locking compression plate,VA-LCP)与普通锁定加压接骨板(locking compression plate,LCP)治疗RüediⅢ型Pilon骨折的临床疗效。方法回顾性分析2018年1月至2020年12月丹阳市人民医院骨科收治的48例RüediⅢ型Pilon骨折患者资料。其中17例采用VA-LCP内固定(研究组),男11例,女6例;年龄31~62岁,平均(46.3±6.7)岁。31例采用传统LCP内固定(对照组),男22例,女9例;年龄36~67岁,平均(48.7±7.6)岁。采集并比较两组患者的术前住院天数、手术时间、术后住院天数、切口愈合、骨折愈合、并发症、术后Burwell-Charnley骨折复位放射学评价和美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)踝与后足评分。结果患者均获随访,随访时间12~18个月,平均(15.2±4.4)个月。两组间年龄、性别、骨折侧别等一般资料以及手术时间、切口愈合、放射学评价、骨折愈合差异无统计学意义(P>0.05)。末次随访踝关节AOFAS评分,研究组70~95分,平均(85.4±11.3)分,其中优11例,良4例,可2例,优良率为88.2%;踝关节跖屈36°~51°,平均(40.3±7.5)°,背伸16°~25°,平均(20.7±3.6)°。对照组56~94分,平均(81.2±14.6)分,其中优18例,良8例,可5例,优良率为83.9%;踝关节跖屈32°~50°,平均(37.4±8.5)°,背伸13°~22°,平均(18.1±3.6)°。两组术后踝关节功能恢复满意,差异无统计学意义。研究组切口乙级愈合1例;对照组切口感染1例,乙级愈合5例,神经激惹1例,肌腱激惹4例。研究组软组织并发症情况优于对照组,差异有统计学意义(P<0.05)。结论VA-LCP与LCP两种钢板在固定RüediⅢ型Pilon骨折时,均能取得较好的临床疗效,具体选择视骨折情况而定。

Objective To compare the clinical effect of variable angle locking compression plate(VA-LCP)and a common locking compression plate(LCP)in the treatment of RüediⅢPilon fractures.Methods A retrospective analysis was conducted of the clinical data of 48 patients with Rüedi-ⅢPilon fractures treated at the People's Hospital of Danyang from January 2018 to December 2020.Of these,17 patients received VA-LCP-based internal fixation(study group),consisting of 11 males and 6 females,aged between 31 and 62 years old,with a mean age of(46.3±6.7)years old.Additionally,31 patients underwent traditional LCP-based internal fixation(control group),including 22 males and 9 females,aged from 36 to 67 years old,with a mean age of(48.7±7.6)years old.Data on operation time,hospital stay,incision healing,fracture healing,and complications were collected during follow-up.Postoperative X-rays were used to determine the Burwell-Charnley radiological score,and the American orthopaedic foot and ankle society(AOFAS)ankle-hindfoot score was employed to assess ankle joint function at the final follow-up.Results All patients were followed up for 12 to 18 months,with an average follow-up time of(15.2±4.4)months.There were no significant differences between the two groups in terms of age,gender,fracture side,preoperative waiting time,operation time,and fracture healing time,as well as postoperative radiological evaluation of Burwell-Charnley fracture reduction(P>0.05).In the study group,the AOFAS score at the last follow-up ranged from 70 to 95,average(85.4±11.3),with 11 excellent cases,4 good cases,2 fair cases,resulting in an excellent and good rate of 88.2%.Ankle plantar flexion was 36°to 51°,average(40.3±7.5)°,and dorsiflexion was 16°to 25°,average(20.7±3.6)°.In the control group,the AOFAS score ranged from 56 to 94,average(81.2±14.6),with 18 excellent cases,8 good cases,5 fair cases,resulting in an excellent and good rate of 83.9%.Ankle plantar flexion was 32°to 50°,average(37.4±8.5)°,and dorsiflexion was 13°to 22°,average(18.1±3.6)°.There was no significant difference in ankle function between the two groups.The incidence of soft tissue complications in the study group was better than that in the control group,and the difference was statistically significant(P<0.05).In the study group,there was 1 case of grade B healing of the incision.In the control group,there were 1 case of incision infection,5 cases of grade B healing,1 case of nerve irritation,and 4 cases of tendon irritation.Conclusion Both VA-LCP and LCP can achieve good clinical efficacy in the fixation of Rüedi-Ⅲpilon fractures,and be selected on the condition of the fracture.