改良双切口锁定加压钢板固定治疗高能量闭合性Pilon骨折疗效分析
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摘要
目的探究改良双切口锁定加压钢板固定对于高能量闭合性Pilon骨折的治疗效果。方法回顾性分析2014年1月—2016年1月广州市第一人民医院南沙医院骨科收治的高能量闭合性Pilon骨折患者68例,其中接受传统手术治疗34例(采用传统的前内侧入路联合腓骨入路,先行腓骨骨折端复位,再行关节面复位,传统组),接受改良双切口锁定加压钢板固定治疗34例(采用改良的前正中切口联合后外侧入路锁定加压钢板固定,改良组),通过查阅临床病例,比较两组的治疗效果。结果改良组术中出血量、手术时间、手术切口长度较传统组差异均无统计学意义(P> 0. 05);术后3个月复查X线片,改良组解剖复位率为88. 2%,高于传统组的70. 6%,差异有统计学意义(χ~2=3. 238,P <0. 05);改良组骨折愈合时间、重返工作岗位时间少于传统组,且并发症发生率较低,差异有统计学意义(P <0. 05);改良组疗效优良率为88. 2%,高于传统组的70. 6%,差异有统计学意义(P <0. 05)。结论改良双切口锁定加压钢板固定可提高高能量闭合性Pilon骨折复位效果,减少康复时间和并发症,疗效显著,值得临床推广使用。
Objective To investigate the effect of modified double-incision locking compression plate fixation on high-energy closed Pilon fractures. Methods A retrospective analysis was conducted in 68 patients with high-energy closed Pilon fractures admitted to the Department of Orthopaedics of Nansha Medical Center of Guangzhou First People's Hospital from Jan. 2014 to Jan. 2016. Among them,34 patients underwent conventional surgery( the traditional anterior medial approach combined with the humeral approach was used,the humerus fracture end was first restored,and then the articular surface was restored,conventional group),and 34 cases were treated with modified double incision locking compression plate fixation( modified anterior median incision combined with posterolateral approach was used,modified group). The treatment effects of the two groups were compared. Results There was no significant difference in the amount of bleeding,operation time and length of surgical incision in the modified group( P > 0. 05). The X-ray films were reviewed 3 months after operation,the anatomic reduction rate of the modified group was 88. 2%,higher than in the traditional group( 70. 6%),and the difference was statistically significant( χ~2= 3. 238,P < 0. 05). The fracture healing time and return to work time in the modified group were less than those of the traditional group,the complication rate was lower,and the difference was statistically significant( P < 0. 05); the excellent and good rate of the modified group was 88. 2%,which was higher than that of the traditional group( 70. 6%),and the difference was statistically significant( P < 0. 05). Conclusion Modified doubleincision locking compression plate fixation can improve the reduction of high-energy closed Pilon fracture,reduce the recovery time and complications,and the curative effect is significant. It is worthy of clinical promotion.
Objective To investigate the effect of modified double-incision locking compression plate fixation on high-energy closed Pilon fractures. Methods A retrospective analysis was conducted in 68 patients with high-energy closed Pilon fractures admitted to the Department of Orthopaedics of Nansha Medical Center of Guangzhou First People's Hospital from Jan. 2014 to Jan. 2016. Among them,34 patients underwent conventional surgery( the traditional anterior medial approach combined with the humeral approach was used,the humerus fracture end was first restored,and then the articular surface was restored,conventional group),and 34 cases were treated with modified double incision locking compression plate fixation( modified anterior median incision combined with posterolateral approach was used,modified group). The treatment effects of the two groups were compared. Results There was no significant difference in the amount of bleeding,operation time and length of surgical incision in the modified group( P > 0. 05). The X-ray films were reviewed 3 months after operation,the anatomic reduction rate of the modified group was 88. 2%,higher than in the traditional group( 70. 6%),and the difference was statistically significant( χ~2= 3. 238,P < 0. 05). The fracture healing time and return to work time in the modified group were less than those of the traditional group,the complication rate was lower,and the difference was statistically significant( P < 0. 05); the excellent and good rate of the modified group was 88. 2%,which was higher than that of the traditional group( 70. 6%),and the difference was statistically significant( P < 0. 05). Conclusion Modified doubleincision locking compression plate fixation can improve the reduction of high-energy closed Pilon fracture,reduce the recovery time and complications,and the curative effect is significant. It is worthy of clinical promotion.
引文
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[7]Klammer G,Kadakia AR,Joos DA,et al.Posterior Pilon fractures:a retrospective case series and proposed classification system[J].Foot Ankle Int,2013,34(2):189-199.
[8]陈业平,宋世锋.Pilon骨折手术治疗进展[J].中国矫形外科杂志,2012,20(4):321-322.
[9]段兴威,蒋涛,刘鹏,等.严重Pilon骨折的外科手术治疗选择[J].中国矫形外科杂志,2010,18(7):610-612.
[10]马爱原,安小刚,刘芳宏,等.双切口锁定加压钢板治疗胫骨Pilon骨折46例[J].实用骨科杂志,2010,16(5):392-393.
[11]王明鑫,刘德昌,王坤,等.改良双切口治疗合并腓骨骨折的Pilon骨折疗效观察[J].中国修复重建外科杂志,2016,30(12):1483-1487.
[2]陈志伟,陈丹,阳海清,等.双切口入路360°内固定治疗高能量闭合性Pilon骨折[J].中国修复重建外科杂志,2015,29(10):1226-1229.
[3]陆庆文,蒋卫平,周竖平,等.Ⅲ型Pillon骨折的治疗策略[J].中国骨与关节损伤杂志,2011,26(7):635-636.
[4]Amorosa LF,Brown GD,Greisberg J.A surgical approach to posterior Pilon fractures[J].J Orthop Trauma,2010,24(3):188-193.
[5]吴多庆.锁定钢板内固定治疗复杂胫骨平台骨折23例疗效研究[J].重庆医学,2011,40(30):3092-3093.
[6]Chen DW,Li B,Aubeeluck A,et al.Open reduction and internal fixation of posterior Pilon fractures with buttress plate[J].Acta Orthop Bras,2014,22(1):48-53.
[7]Klammer G,Kadakia AR,Joos DA,et al.Posterior Pilon fractures:a retrospective case series and proposed classification system[J].Foot Ankle Int,2013,34(2):189-199.
[8]陈业平,宋世锋.Pilon骨折手术治疗进展[J].中国矫形外科杂志,2012,20(4):321-322.
[9]段兴威,蒋涛,刘鹏,等.严重Pilon骨折的外科手术治疗选择[J].中国矫形外科杂志,2010,18(7):610-612.
[10]马爱原,安小刚,刘芳宏,等.双切口锁定加压钢板治疗胫骨Pilon骨折46例[J].实用骨科杂志,2010,16(5):392-393.
[11]王明鑫,刘德昌,王坤,等.改良双切口治疗合并腓骨骨折的Pilon骨折疗效观察[J].中国修复重建外科杂志,2016,30(12):1483-1487.