目的：探讨微创切口插入技术结合内侧锁定解剖钢板在 Ruedi-Allgower II 型 Pilon 骨折治疗上的优势。方法随访2009年3月至2014年3月，在我院接受手术的 Ruedi-Allgower II 型、Tscherne-Gotzen 分度为 I 度以下的 Pilon 骨折患者30例，A 组15例，接受微创切口插入技术结合内侧锁定解剖钢板治疗， B 组15例，接受常规切口外侧锁定解剖钢板治疗。平均随访24个月。结果按照 Burwell-Charnley 放射学评价标准评定复位质量，A 组：解剖复位10例，复位可 5例；B 组：解剖复位11例，复位可4例；经t 检验， P＞0.05，两种手术方案在骨折复位质量上差异无统计学意义。根据 Mazur 等制定的踝关节症状与功能评分系统对手术关节进行功能评估，A 组：优11例、良2例、可2例，优良率86.7%。B 组：优8例、良2例、可 5例，优良率66.7%，经t 检验，P≤0.05，两种手术方案在术后踝关节功能恢复上差异有统计学意义。结论微创切口插入技术结合内侧锁定解剖钢板在 Ruedi-Allgower II 型、Tscherne-Gotzen 分度为 I 度以下的 Pilon 骨折的治疗上较常规切口外侧锁定解剖钢板具有损伤小，恢复快，有效减少并发症发生等优点。%Objective To evaluate the efficacy of minimally invasive approach combined with medial locking plate in the treatment of Ruedi-Allgower II Pilon fractures.Methods Totally 30 patients of Ruedi-Allgower II, Tscherne-Gotzen I Pilon fractures were followed up from March 2009 to March 2014. The average follow-up was 24 months. All patients were divided into 2 groups. Group A (n = 15 ): minimally invasive approach combined with medial locking plate. Group B ( n = 15 ): conventional incision combined with lateral locking anatomic plate.Results According to Burwell-Charnley in radiology: Group A: anatomical reattachment in 10 cases, fair in 5 cases; Group B: anatomical reattachment in 11 cases, fair in 4 cases; no statistical differences in 2 approaches on the fracture reduction quality ( P> 0.05 ). According to Mazur’s criterion: Group A: excellent in 11 cases, good in 2 cases and fair in 2 cases, excellent and good rate was 86.7%; Group B: excellent in 8 cases, good in 2 cases and fair in 5 cases, the excellent and good rate was 66.7%; statistical differences existed in 2 approaches on the postoperative ankle function recovery (P≤0.05 ).Conclusions Minimally invasive approach combined with medial locking plate has advantages of smaller lesion, quicker recovery and less complications in the treatment of Ruedi-Allgower II, Tscherne-Gotzen I Pilon fractures comparing with the conventional incision combined with lateral locking anatomic plate.
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