延期微创经皮锁定钢板治疗Ⅱ、Ⅲ型Pilon骨折的病例对照研究

摘要

Objective:To explore the clinical efficacy of delayed open reduction and internal fixation with minimally invasive percutaneous locking compression plate for the treatment of type II and III Pilon fractures. Methods: From January 2007 to September 2009,32 patients with type II and III Pilon fractures were treated with open reduction and anatomic plate fixation (AP group) and minimally invasive percutaneous locking compression plate osteosynthesis (LCP group). There were 11 males and 6 females in AP group,with an average age of (37.4±13.3) years (ranged, 19 to 55 years). And there were 10 males and 5 females in LCP group,with an average age of (34.6±11.3) years (ranged, 21 to 56 years). The operating time,fracture healing time,aligned angulation and ankle function were compared between the two groups. Results:All the patients were followed up, and the during ranged from 12 to 25 months, with a mean of(15.0± 1.7) months. The average operation time was(76.5±8.3) min for AP group and (58.3±3.4) min for LCP group;the average time of fracture healing was (20.5±0.4) weeks for AP group and (15.7±0.2) weeks for LCP group;the total angulation between anterior posterior film and lateral film was averaged (6.6±0.5)° for Apgroupand(3.6±0.2)° for LCP group. As to above index,the results of LCP group were better than those of AP group(P< 0.05). According to Kofoed criteria for ankle joint,the results of LCP group were better than those of AP group in ankle joint pain.wakling and ankle joint function (P<0.05). Conclusion:The method of minimally invasive percutaneous locking compression plate internal fixation is effective in the treatment of Pilon fracture with less invasion,faster bone union,more stabilized fixation,quicker recovery of ankle function and fewer complications, which is more advantaged for type II and HI Pilon fractures.%目的:探讨延期微创锁定钢板内固定治疗Ⅱ、Ⅲ型Pilon骨折的疗效.方法:2007年1月至2009年9月,采用切开复位解剖型钢板内固定(AP组)和微创经皮锁定加压钢板内固定(LCP组)治疗胫骨Ⅱ、Ⅲ型Pilon骨折共32例,其中AP组17例,男11例,女6例,年龄19～55岁,平均(37.4±13.3)岁；LCP组15例,男10例,女5例,年龄21～56岁,平均(34.6±11.3)岁.比较2组的手术时间、骨折愈合时间、骨折成角及踝关节功能情况.结果:32例均获随访,时间12～25个月,平均(15.O±1.7)个月.AP组与LCP组平均手术时间分别为(76.5±8.3)min和(58.3±3.4) min,骨折愈合时间分别为(20.5±0.4)周和(15.7±0.2)周,正侧位成角之和分别为(6.6±0.5)°和(3.6±0.2)°,LCP组的上述指标均优于AP组(P＜0.05).按照Kofoed踝关节功能评分标准,LCP组踝关节疼痛、行走功能、活动度3方面均优于AP组(P＜0.05).结论:延期微创经皮LCP内固定治疗Pilon骨折效果尚可,具有手术创伤小、固定强度高、骨折愈合快、踝关节功能恢复好等优点,是治疗Ⅱ、Ⅲ型Pilon骨折较好的手术方式之一.