胫骨Pilon骨折前外侧钢板联合内侧微创钢板接骨

Anterolateral plate combined with medial minimally invasive plate osteosynthesis for tibial Pilon fractures

摘要:

[目的] 比较前外侧钢板联合内侧微创接骨板（minimal invasive plate osteosynthesis, MIPO） 与单纯前外侧固定胫骨Pilon 骨折的临床效果。[方法] 2019 年3 月—2022 年5 月胫骨远端Pilon 骨折患者115 例采用抽签法随机分两组。58 例接受前外侧固定联合内侧MIPO（联合组），57 例采用单纯前外侧固定（前外组）。比较两组围手术期、随访及影像资料。[结果] 联合组手术时间[(75.4±14.0) min vs (68.6±13.7) min, P=0.010]、切口长度[(7.0±0.5) cm vs (4.8±0.4) cm, P＜0.001]、术中透视次数[(9.2±2.0) 次vs (6.4±1.8) 次, P＜0.001] 均显著多于前外组，但前者的术中失血量[(54.8±10.2) ml vs (60.5±10.5) ml, P=0.004]、住院时间[(8.5±2.4) d vs (10.3±3.1) d, P＜0.001]、下地行走时间[(11.0±2.5) d vs (16.5±3.0) d, P＜0.001] 及完全负重活动时间[(101.5±25.0) d vs(120.4±25.2) d, P＜0.001] 均显著少于前外组。随时间推移，两组VAS 评分、AOFAS 评分及背伸-跖屈ROM 均显著改善（P＜0.05），联合组术后3 个月VAS 评分[(2.0±0.5) vs (2.7±0.8), P＜0.001]、AOFAS 评分[(68.8±12.6) vs (63.5±11.2), P=0.019]、背伸-跖屈ROM [(55.0±6.5)° vs (51.5±7.0)°, P=0.006] 均显著优于前外组，但末次随访时，两组上述指标的差异均无统计学意义（P＞0.05）。影像方面，两组术后3 个月及末次随访时，关节面对合、外侧胫骨远端机械角、前侧胫骨远端角均较术前显著改善（P＜0.05），但K-L 评级无显著变化（P＞0.05），相应时间点，两组上述影像指标的差异均无统计学意义（P＞0.05）。[结论] 前外侧联合内侧MIPO 入路手术治疗胫骨远端Pilon 骨折有利于踝关节功能早期恢复。

Abstract:

[Objective] To compare the clinical efficacy of anterolateral (AL) plate combined with medial minimal invasive plate osteo-synthesis (MIPO) versus anterolateral fixation alone for tibial Pilon fractures. [Methods] From March 2019 to May 2022, 115 patients withPilon fracture of distal tibia were randomly divided into two groups by drawing lots. Of them, 58 patients received AL plate combined withmedial MIPO (the combined group), while the remaining 57 patients received AL fixation alone (the AL group). The perioperative, followupand imaging documents of the two groups were compared. [Results] Although the combined group was inferior to the AL group in termsof operation time [(75.4±14.0) min vs (68.6±13.7) min, P=0.010], incision length [(7.0±0.5) cm vs (4.8±0.4) cm, P＜0.001], intraoperative flu-oroscopy times [(9.2±2.0) times vs (6.4±1.8) times, P＜0.001], the former proved significantly superior to the latter in terms of intraoperativeblood loss [(54.8±10.2) ml vs (60.5±10.5) ml, P=0.004], hospital stay [(8.5±2.4) days vs (10.3±3.1) days, P＜0.001], postoperative walkingtime [(11.0±2.5) days vs (16.5±3.0) days, P＜0.001] and time to resume full weight-bearing activity [(101.5±25.0) days vs (120.4±25.2) days,P＜0.001]. The VAS and AOFAS score, as well as dorsal extension-plantar flexion ROM in both groups were significantly improved overtime (P＜0.05). The combined group was significantly better than the AL group in terms of VAS score [(2.0±0.5) vs (2.7±0.8), P＜0.001], AO-FAS score [(68.8±12.6) vs (63.5 ±11.2), P=0.019] and ROM [(55.0±6.5)° vs (51.5±7.0)°, P=0.006] 3 months postoperatively, whereas whichbecame not statistically significant between the two groups at the latest follow-up (P＞0.05). Radiographically, the articular congruency, me-chanical lateral distal tibial angle (mLDTA) and anterior distal tibial angle (ADTA) significantly improved (P＜0.05), while K-L grade re-mained unchanged significantly (P＞0.05) at 3 months after surgery and the last follow-up compared with those preoperatively, which werenot statistically significant at any corresponding time points between the two groups (P＞0.05). [Conclusion] The anterolateral plate combined with medial MIPO for distal tibial Pilon fractures is beneficial to the early recovery of ankle joint function.