前外侧联合内侧微创入路治疗AO-C型Pilon骨折

Internal fixation through anterolateral combined medial minimal invasive approach for AO type C pilon fractures

[目的]探讨采用前外侧联合内侧微创入路治疗AO-C型Pilon骨折的疗效。[方法]回顾性分析2013年9月～2016年10月采用前外侧联合内侧微创入路,行切开复位内固定术治疗的31例AO-C型Pilon骨折患者,其中C1型7例,C2型18例,C3型6例,均为闭合性骨折。记录关节活动度、手术时间、出血量、骨折愈合时间及手术并发症,采用美国足踝外科协会(AOFAS)踝-后足评分及疼痛视觉模拟评分(VAS)评定临床效果。[结果]患者均顺利手术,手术时间58～105 min,平均(78.62±20.32) min,术中出血量50～110 ml,平均(75.32±20.72) ml。所有病例随访12～32个月,平均(17.12±1.49)个月。骨折愈合时间3～6个月,平均(3.21±1.49)个月。随术后时间延长,AOFAS踝-后足评分显著增加,而VAS评分显著减少,不同时间点间差异有统计学意义(P<0.05)。末次随访时,患侧与健侧踝关节主动屈伸活动范围比较差异无统计学意义(P>0.05),临床结果评级为优26例,良3例,可2例,优良率93.55%。3例出现创伤性关节炎,经改变日常生活方式和NSAIDs缓解症状。[结论]前外侧联合内侧微创入路治疗AO-C型Pilon骨折,骨折端显露充分,软组织剥离少,术后并发症少,可早期功能锻炼,关节活动度恢复良好。

[Objective] To explore the clinical outcomes of open reduction and internal fixation(ORIF) through anterolateral combined with medial minimally invasive approach for AO type C pilon fractures. [Methods] From September 2013 to October 2016, 31 patients who underwent surgical treatment for AO type C pilon closed fractures including C1 in 7 cases, C2 in 18 cases and C3 in 6 cases, were retrospectively analyzed. All cases underwent ORIF through anterolateral combined with medial minimally invasive approach. The operation time, blood loss, fracture healing time and surgical complications were recorded. Additionally, AOFAS ankle-hind foot score, visual analogue scale(VAS) for pain and the range of motion(ROM) of the joint were used for assessment of clinical consequences. [Results] All patients received successful operation with operation time of(78.62±20.32) min on average(ranged 58 ~ 105 min) and intraoperative blood loss of(75.32±20.72) ml(ranged 50 ~110 ml). The follow up lasted for 12 to 32 months with an average of(17.12±1.49) months. The patients achieved fracture healing from 3 to 6 months with an average of(3.21±1.49)months postoperatively. As time went on after operation, the AOFAS ankle-hind foot scores significantly increased, whereas the VAS scores significantly decreased(P<0.05). At the latest follow up, no a statistically significant difference was proved in active ankle ROM between the affected and healthy sides(P>0.05), in addition, the clinical outcomes were graded as excellent in26 patients, good in 3 and fair in 2, associated with the excellent and good rate of 93.55% based on AOFAS score, despite of the fact that 3 patients surfed from symptomatic traumatic arthritis, which subsided by modified daily life and NSAIDs drugs. [Conclusion] The ORIF through the anterolateral combined with the medial minimally invasive approach for AO type C pilon fractures take benefits of sufficient exposure to the fracture, less soft tissue dissection, less postoperative complications, early functional exercise and good functional recovery.