不同手术固定方式治疗AO-C3型Pilon骨折的临床对照研究

摘要

目的 研究不同手术固定方式治疗AO-C3型Pilon骨折的临床价值.方法 采用回顾性方法对2011年2月至2015年4月骨科收治的60例AO-C3型 Pilon骨折患者进行分析,按不同的手术方案分为A、B、C组.A组采用切开复位胫骨远端解剖钢板内固定手术治疗方案,16例;B组采用微创经皮锁定钢板内固定手术治疗方案,20例;C组采用有限内固定结合外固定手术治疗方案,24例.术后2周观察3组患者踝关节功能恢复情况、骨折重建质量,随访时间为6~24个月,观察术后早期及远期并发症发生情况.结果 3组患者踝关节功能恢复优良率、骨折重建质量及远期并发症发生情况比较,差异均无统计学意义(P>0.05);A组患者早期并发症发生率高于B组和C组,差异均有统计学意义(P<0.05),B、C两组比较差异无统计学意义(P>0.05).结论 微创经皮锁定钢板内固定手术和有限内固定结合外固定手术治疗能够有效减少 AO-C3型Pilon骨折患者早期并发症的发生,对于大范围感染、骨折区软组织缺损严重患者选取有限内外固定结合有一定优势.%Objective To study the clinical value of different operative fixation modes in treating AO-C3 Pilon fracture.Methods The retrospective analysis method was adopted to analyze 60 cases of AO-C3 Pilon fracture in the orthopedic department of our hospital from 2011 to 2015.The patients were divided into the group A,B and C according to different operation schemes.The group A adopted the open reduction and distal tibia anatomical plate internal fixation (16 cases),the group B adopted minimally invasive percutaneous locking plate internal fixation (20 cases) and the group C adopted limited internal fixation combined with external fixation (24 cases).The ankle joint function recovery situation and fracture reconstruction quality at postoperative 2 weeks were observed in 3 groups.The follow up lasted for 6-24 months.The occurrence situation of postoperative early complications and long-term complications were observed.Results The excellent rate of joint function recovery,fracture reconstruction quality and long-term complications occurrence had no statistical difference among 3 groups (P>0.05);the occurrence rate of postoperative early complications in the group A was higher than that in the group B and C,the difference was statistically significant(P<0.05),but there was no statistical difference between the group B and C.Conclusion The operation treatment of minimally invasive percutaneous locking plate internal fixation and limited internal fixation combined with external fixation can effective reduce the occurrence of early complications in the patients with AO-C3 Pilon fracture.Selecting the limited internal fixation combined with external fixation in the patients with large range infection and severe soft tissue defect has some advantages.