不同内固定方式联合入路治疗Klammer Ⅲ型后pilon骨折效果  

Effects of different internal fixation methods combined approach in treatment of Klammer Ⅲ type posterior pilon fracture

作　　者：衡科[1] 陶涛[1] 魏辉 张云坤[1] 耿庆贺 HENG Ke;TAO Tao;WEI Hui;ZHANG Yunkun;GENG Qinghe(Department of Orthopedics,The Second People′s Hospital of Changzhou Affiliated to Nanjing Medical University,Changzhou,Jiangsu,213003;Department of Orthopedics,Pizhou People′s Hospital Affiliated to Xuzhou Medical University,Xuzhou,Jiangsu,221300)

机构地区：[1]南京医科大学附属常州市第二人民医院骨科,江苏常州213003 [2]徐州医科大学附属邳州市人民医院骨科,江苏徐州221300

出　　处：《实用临床医药杂志》2021年第12期66-69,共4页Journal of Clinical Medicine in Practice

基　　金：中国博士后科学基金面上资助项目(2020M681739)。

摘　　要：目的探讨不同内固定方式联合入路治疗Klammer Ⅲ型后pilon骨折的临床疗效。方法对20例Klammer Ⅲ型后pilon骨折患者进行回顾性分析,其中9例采用空心螺钉内固定(空心钉组),11例采用钢板或钢板加空心螺钉内固定(钢板组)。术后采用视觉模拟评分法(VAS)和美国足踝外科协会(AOFAS)踝-后足评分评估疗效。结果20例患者骨折均愈合,1例患者术后出现皮肤坏死,换药1个月后愈合。患者术后未出现骨折不愈合、钢板螺钉断裂及松动。与术前相比,患者术后3、6个月VAS评分均降低,AOFAS评分均提高,差异有统计学意义(P<0.05)。钢板组术前VAS评分高于空心钉组,差异有统计学意义(P<0.05);术后2组患者VAS评分均降低,差异无统计学意义(P>0.05)。术后3个月,钢板组AOFAS评分高于空心钉组,差异有统计学意义(P<0.05);2组患者术后6个月AOFAS评分均提高,差异无统计学意义(P>0.05)。结论Klammer Ⅲ型后pilon骨折采用空心钉或钢板固定骨折复位疗效均较好,且内固定联合入路治疗可以充分暴露骨折断端,术后疗效良好。Objective To investigate the clinical effect of different internal fixation methods combined approach in the treatment of Klammer Ⅲ type posterior pilon fracture.Methods Twenty patients with Klammer Ⅲ type posterior pilon fractures were retrospectively analyzed.Among them,9 cases underwent internal fixation with hollow nails(hollow nail group),and 11 cases underwent internal fixation with steel plate or steelplate plus hollow nails(steel plate group).After surgery,Visual Analogue Scale(VAS)and American Orthopedic Foot Andankle Society(AOFAS)ankle-hindfoot scale were used to evaluate the efficacy.Results Fracture healing was observed in all 20 patients,and skin necrosis occurred in 1 case after surgery,which healed after dressing change for 1 month.There was no fracture nonunion,fracture and loosening of plate and screw after operation.Compared with the patients before surgery,the VAS scores of patients 3 and 6 months after surgery were significantly decreased,and the AOFAS scores were significantly increased(P<0.05).The preoperative VAS score in the steel plate group was significantly higher than that of patients with hollow nail fixation(P<0.05).The postoperative VAS scores in two groups were decreased,and the difference was not statistically significant(P>0.05).The AOFAS score in the steel plate group was significantly higher than that of patients with hollow nail fixation 3 months after surgery(P<0.05).At 6 months after surgery,AOFAS scores in two groups were increased,and the difference was not statistically significant(P>0.05).Conclusion Klammer Ⅲ type posterior pilon fracture with cannulated nail or steel plate fixation for fracture reduction is effective,and internal fixation combined with approach can fully expose the fracture end,and has better postoperative effect.

关 键 词：KlammerⅢ型后pilon骨折 骨折固定术 手术入路 空心钉 胫骨 钢板固定 

分 类 号：R681.8[医药卫生—骨科学] R683.42[医药卫生—外科学]