应用四柱理论指导Pilon骨折治疗的疗效观察

摘要

Objective To evaluate the clinical value of four column theory in the treatment of Pilon fractures. Methods From January 2011 to January 2015, the clinical data of 34 cases of Pilon fractures were retrospectively analyzed, and divided into four column theory group (18 cases) and conventional group (16 cases). The rate of anatomical reduction, postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and postoperative complications were compared between two groups. Results All 34 cases were followed up for 8 to 36 months. The incidence of postoperative complications in the conventional group (4/16) was higher than in four column theory group (2/18). There were significant differences in the rate of anatomical reduction and the AOFAS scores on the final follow⁃up between the two groups (P<0.05). Conclusion The four column theory can help to guide the surgery of Pilon fracture to gain more excellent reduction and selection of internal fixation. It is beneficial to ankle function rehabilitation.%目的：观察解剖四柱理论指导Pilon骨折治疗的疗效。方法对2011年1月至2015年1月于我院手术治疗的34例Pilon骨折病人的临床资料进行回顾性分析，根据是否应用四柱理论指导手术治疗分为四柱理论组（18例）和常规组（16例），观察两组病人的骨折复位情况以及并发症发生情况，术后比较两组间的美国足踝外科医师协会（AOFAS）踝与后足功能评分。结果34例病人均获得随访，随访时间为8~36个月。所有病人均骨折愈合；四柱理论组发生2例浅表感染（2/18），常规组发生深部感染1例、浅表感染1例、局部皮肤坏死2例（4/16）；术后第3天，四柱理论组的骨折解剖复位率为77.78%，常规组为68.75%，且末次随访时，常规组出现3例骨折复位丢失；术后1个月时，四柱理论组和常规组的AOFAS评分分别为（77.3±3.1）分、（76.1±3.3）分，差异无统计学意义（P＞0.05），而末次随访时，四柱理论组的AOFAS评分为（79.8±2.9）分，常规组为（70.5±2.3）分，差异有统计学意义（t=9.315，P=0.001）。结论四柱理论对Pilon骨折的手术治疗有明确的指导作用，能使骨折获得更优良的复位和更佳的内固定选择，有利于踝关节功能的恢复。