两种入路开放复位内固定治疗后Pilon骨折  

Extended modified posteromedial approach versus posterolateral approach for open reduction and internal fixation of posterior Pilon fracture

作　　者：张钦明[1] 吴彬[1] 褚风龙[1] 韩亮[1] 王海滨[1] ZHANG Qin-ming;WU Bin;CHU Feng-long;HAN Liang;WANG Hai-bin(Department of Traumatic Orthopaedics,The Affiliated Hospital of Jining Medical University,Jining 272000,China)

机构地区：[1]济宁医学院附属医院创伤骨科,山东济宁272000

出　　处：《中国矫形外科杂志》2020年第18期1666-1669,共4页Orthopedic Journal of China

基　　金：济宁医学院贺林院士基金面上项目(编号:JYHL2018FMS13)。

摘　　要：[目的]比较后外侧入路和延长改良后内侧入路切开复位内固定治疗后Pilon骨折的临床效果。[方法]回顾性分析2015年1月~2018年12月采用切开复位内固定治疗后Pilon骨折67例患者。其中,35例采用后外侧入路,32例采用延长改良后内侧入路,比较两组围手术期、随访和影像资料。[结果]两组患者均顺利完成手术,术中均无严重并发症发生。延长改良后内侧入路组手术时间及术中出血量均优于后外侧入路组(P<0.05)。随访12个月以上,两组骨折愈合时间比较差异无统计学意义(P>0.05)。末次随访时延长改良后内侧入路组AOFAS评分优于后外侧入路组(P<0.05),但两组间VAS评分差异无统计学意义(P>0.05)。影像显示延长改良后内侧入路组术后骨折复位质量优于后外侧入路组(P<0.05)。[结论]与后外侧入路相比,延长改良后内侧入路可提供更好的术野范围,对后Pilon骨折进行直视下复位,可减少手术时间与出血量,提高复位质量。[Objective] To compare the clinical outcomes of open reduction and internal fixation(ORIF) through extended modified posteromedial approach versus posterolateral approach for posterior Pilon fracture. [Methods] A retrospective study was conducted on 67 patients who underwent ORIF with buttress plate for posterior Pilon fracture from January 2015 to December 2018. Of them, 35 patients had operation performed through the posterolateral approach(the PL group), while 32 patients received ORIF through extended modified posteromedial approach(the EMPM group). The perioperative, follow-up and radiographic data were compared between the two groups. [Results] All the patients in both groups had operation finished successfully with no serious complications during the operation. The EMPM group proved significantly superior to the PL group regarding to operation time and intraoperative blood loss(P<0.05). At the latest followed up more than 12 months, all patients got bony fracture healing without a statistical difference in fracture healing time between them(P>0.05). The EMPM group was significantly superior to the PL group in AOFAS score(P<0.05), although there was no statistical significance in VAS score between them at the latest follow-up(P>0.05). In term of radiographic assessment, the EMPM group achieved significantly higher fracture reduction quality than the PL group(P<0.05). [Conclusion] The extended modified posteromedial approach has advantages of expanding operative field, shortening operation time, reducing blood loss and improving fracture reduction quality over the posterolateral approach for open reduction and internal fixation of posterior Pilon fractures.

关 键 词：后Pilon骨折 手术入路 切开复位内固定 支撑钢板 

分 类 号：R683.42[医药卫生—骨科学]