固定牵开复位器下微创经皮钢板固定Pilon骨折△

Minimally invasive plate osteosynthesis with a large distractor for Pilon fracture

摘要:

［目的］探讨固定牵开复位器下微创经皮钢板固定Ⅱ、Ⅲ型 Pilon 骨折的临床效果。［方法］回顾性分析 2017 年 3 月 —2020 年 4 月本院收治的 48 例Ⅱ、Ⅲ型 Pilon 骨折患者的临床资料，依据术前医患沟通结果，28 例采用固定牵引复位器下微创经皮钢板固定术治疗 （复位器组），20 例采用常规开放复位内固定术治疗 （常规组）。比较两组围手术期资料、随访及影像资料 ［结果］ 两组患者均顺利完成手术。复位器组手术时间、术中失血量、透视次数及切口长度均显著优于常规组 （P< 0.05），两组切口愈合等级及住院时间差异无统计学意义 （P>0.05）；随访 12 个月以上，与术前相比，末次随访时两组 VAS 评分显著降低（P<0.05），而 AOFAS 评分、ROM 显著增加（P<0.05），相应时间点，两组间上述指标的差异均无统计学意义（P> 0.05）。影像方面，按 Burwell-Charnley 的标准，两组骨折复位质量差异无统计学意义 （P>0.05）。两组骨折影像愈合时间的差异无统计学意义 （P>0.05）。［结论］ 固定牵开复位器微创经皮钢板固定 Pilon 骨折具有手术时间短、切口小、术中透视次数少和出血量少的优点。

Abstract:

[Objective] To investigate the clinical outcomes of minimally invasive plate osteosynthesis (MIPO) with a large distractor for type II and III Pilon fractures. [Methods] A retrospective study was done on 48 patients who underwent surgical treatment for type II and III Pilon fractures in our hospital from March 2017 to April 2020. According to the consequence of preoperative doctor-patient commu- nication, 28 patients were treated with MIPO using a large distractor (the distractor group) , while the remaining 20 patients were treated with conventional open reduction and internal fixation (ORIF) (the conventional group). The perioperative, follow- up and imaging docu- ments were compared between the two groups. [Results] All patients in both groups had operation completed successfully. The distractor group proved significantly superior to the conventional group in terms of operative time, intraoperative blood loss, fluoroscopy times and in- cision length (P＜0.05) , but there was no significant difference in incision healing grade and hospital stay between the two groups (P＞0.05) . At the latest follow up lasted for more than 12 months, the VAS scores significantly decreased (P＜0.05) , while the AOFAS score and ROM significantly increased in both groups compared with those preoperatively (P＜0.05) . However, there were no statistical significances in the above items between the two groups at any corresponding time point (P＞0.05) . Radiographically, there was no significant difference in frac- ture reduction quality between the two groups according to Burwell-Charnley's criteria (P＞0.05) . In addition, there was no significant dif- ference in fracture healing time on images between the two groups (P＞0.05) . [Conclusion] The MIPO with a large distractor for Pilon frac- ture has the advantages of short operation time, small incision, less intraoperative fluoroscopy and less blood loss.