两种复位顺序手术治疗伴腓骨骨折的Pilon骨折比较

Comparison of two sequences of open reduction and internal fixation for Pilon fracture accompanied with fibular fracture

摘要:

［目的］ 比较合并腓骨骨折的 Pilon 骨折术中复位顺序的临床效果。［方法］ 回顾性分析 2018 年 1 月—2021 年 1 月 150 例合并腓骨骨折的 OA/OTA B、C 型 Pilon 骨折行开放复位内固定患者的临床资料。依据术前医患沟通结果，74 例先处理腓骨，76 例先处理胫骨，比较两组临床及影像学指标。［结果］两组患者均顺利完成手术，腓骨组手术时间、切口总长度、透视次数、术中出血量、切口愈合情况均显著优于胫骨组（P<0.05）。两组完全负重时间的差异无统计学意义（P>0.05）。术后随时间推移，两组踝 aROM 及 AOFAS 评分均显著增加 （P<0.05），但相同时间点，两组上述指标的差异无统计学意义 （P>0.05）。 影像方面，两组骨折复位质量、骨折愈合时间、末次随访内固定物的改变情况差异均无统计学意义 （P>0.05）。［结论］ 对于 OA/OTA B、C 型 Pilon 骨折开放复位内固定，优先处理腓骨可显著减少手术创伤，提高手术效率。

Abstract:

[Objective] To compare the clinical outcomes of two sequences of open reduction and internal fixation (ORIF) of Pilon frac- ture accompanied with fibular fracture. [Methods] A retrospective study on 150 patients who underwent ORIF for OA/OTA type B and C Pi- lon fractures complicated with fibular fracture from January 2018 to January 2021. According to preoperative doctor-patient communica- tion, 74 patients had the fibula treated first, while the remaining 76 patients had the tibia treated first. The clinical and imaging data were compared between the two groups. [Results] All the patients in both groups were operated on successfully. The fibular group proved signifi- cantly superior to the tibial group in terms of the operation time, total incision length, times of fluoroscopy, intraoperative blood loss, and in- cision healing (P<0.05) . However, there was no significant difference in the time to resume full weight-bearing activity between the two groups (P>0.05) . The active ankle range of motion (aROM) and AOFAS scores significantly increased over time in both groups (P<0.05) , whereas no significant differences were noted in abovesaid items between the two groups at the matching time point (P>0.05) . Radiographi- cally, there were no significant differences in fracture reduction quality, fracture healing time, and changes of internal fixators at the last fol- low-up between the two groups (P>0.05) . [Conclusion] For open reduction and internal fixation of OA/OTA type B and C Pilon fractures accompanied by a fibular fracture, prioritizing the fibula can significantly reduce surgical trauma and improve surgical efficiency.