切开复位内固定与MIPPO技术治疗Pilon骨折的疗效比较  

Comparison of open reduction and internal fixation with minimally invasive percutaneous plate osteosynthesis for treatment of Pilon fractures

作　　者：王占长 杜立[2] 苏志雄 李非 梁宁 曹轶伦 

机构地区：[1]清华大学第一附属医院骨科,北京100016 [2]北京军区总医院医务部

出　　处：《中国骨与关节损伤杂志》2015年第10期1072-1075,共4页Chinese Journal of Bone and Joint Injury

基　　金：国际科技合作计划项目(2010DFA31250)

摘　　要：目的 比较切开复位内固定与微创经皮钢板内固定技术（MIPPO）治疗Pilon骨折的手术疗效。方法 自2009-01—2013-08诊治98例Pilon骨折,49例采用切开复位内固定治疗（切开复位组）,49例采用MIPPO技术治疗（MIPPO组）。比较2组手术时间、术中出血量、骨折愈合时间、并发症、踝关节功能Mazur评分。结果 98例均获得随访,随访时间8-60（23.1±5.5）个月。与切开复位组相比,MIPPO组术中出血量减少,骨折愈合时间缩短,并发症发生率更低,踝关节功能Mazur评分优良率更高,差异均有统计学意义（P〈0.05）;但2组手术时间相当,差异无统计学意义（P〉0.05）。MIPPO组Ruedi-AllgowerⅢ型骨折患者及重度软组织损伤患者Mazur评分高于切开复位组,差异有统计学意义（P〈0.05）。结论 采用MIPPO技术治疗Pilon骨折,在保证骨折稳定固定的基础上,可以避免软组织广泛剥离,对机体创伤小,局部感染机会少,骨折愈合充分,同时相应并发症少,临床疗效好。Objective To compare the clinical efficacy of open reduction and internal fixation with minimally invasive percutaneous plate osteosynthesis for treatment of Pilon fractures.Methods A retrospective review was performed on a consecutive series of 98 patients with Pilon fractures who underwent open plating or minimally invasive percutaneous plate osteosynthesis.Forty-nine patients were treated with open reduction,and 49 were treated with the MIPPO technique without exposing a fracture site itself.Patient demographics,ankle function using Mazur score,operation time,union rate,complications,and radiographic evaluation were evaluated.Results All the patients were followed-up from 8-60 months and the average follow-up time was（23.1 ±5.5）months.There were no statistically significant differences in the demographic data and fracture characteristics between the two groups.Bleeding and complications were less,and Mazur score of ankle function was higher,and fracture union were significantly shorter in the MIPPO group than the open reduction and internal fixation group（P〈0.05）; however operation time did not differ significantly between the two groups（P〉0.05）.Conclusion With a sound knowledge of the operative technique and by careful preoperative planning the MIPPO technique represents an excellent results and can reduce incidence rate of complications in treatment of Pilon fractures.

关 键 词：PILON骨折 微创经皮钢板内固定术 切开复位 内固定 

分 类 号：R687.3[医药卫生—骨科学]