新型Pilon钢板治疗C型Pilon骨折的疗效研究  

Effectiveness of new Pilon plate in treatment of type C Pilon fracture

作　　者：余进伟[1] 陈豪杰 张雁儒[2] 陈旭[1] 柴乐 白伟[1] 王斌[1] 史志远 孙广涛 YU Jinwei;CHEN Haojie;ZHANG Yanru;CHEN Xu;CHAI Le;BAI Wei;WANG Bin;SHI Zhiyuan;SUN Guangtao(Department of Orthopaedics,the Second People's Hospital of Jiaozuo,Jiaozuo Henan,454000,P.R.China;Institute of Orthopaedics,Henan PolytechnicUniversity,JiaozuoHenan,454000,P.R.China;Department of Orthopaedics,People's Hospital of Boai County,Boai Henan,454400,P.R.China)

机构地区：[1]焦作市第二人民医院骨科,河南焦作454000 [2]河南理工大学骨科研究所,河南焦作454000 [3]博爱县人民医院骨科,河南博爱454400

出　　处：《中国修复重建外科杂志》2023年第1期31-36,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：河南理工大学基本科研业务费专项项目(NSFRF220413)。

摘　　要：目的 通过与传统L型接骨板进行比较,探讨新型Pilon钢板治疗C型Pilon骨折的疗效。方法回顾性分析2018年5月—2020年1月手术治疗且符合选择标准的57例C型Pilon骨折患者临床资料。其中,骨折采用新型Pilon钢板固定32例(试验组),L型接骨板固定25例(对照组)。两组患者性别、年龄、致伤原因、骨折侧别及分型、受伤至手术时间等一般资料比较,差异均无统计学意义(P>0.05)。记录两组手术时间以及并发症发生情况。术后X线片复查,根据Burwell-Charnley影像学评价标准观察骨折复位质量及骨折愈合情况;根据Johner-Wruhs评分标准以及美国矫形足踝协会(AOFAS)评分标准评价踝关节功能。结果 两组手术均顺利完成,试验组手术时间较对照组缩短(t=–3.025,P=0.005)。术后对照组2例出现切口坏死,两组其余患者切口均Ⅰ期愈合。患者均获随访,随访时间8~16个月,平均10.1个月;两组随访时间差异无统计学意义(t=0.433,P=0.667)。X线片复查示试验组踝关节复位达优28例、良4例,优良率100%;对照组达优15例、良5例、可5例,优良率80.0%;两组骨折复位质量差异有统计学意义(Z=–2.565,P=0.010)。两组骨折均达愈合,其中试验组愈合时间为(16.59±3.78)周,对照组为(17.80±3.81)周,差异无统计学意义(t=–1.191,P=0.239)。末次随访时,试验组踝关节功能按照Johner-Wruhs评分标准达优25例、良7例,优良率100%;AOFAS评分为(90.9±4.5)分。对照组达优16例、良5例、可4例,优良率84.0%;AOFAS评分为(85.2±10.0)分。试验组踝关节功能评分均优于对照组,差异有统计学意义(P<0.05)。随访期间除对照组1例发生踝关节创伤性关节炎外,两组均无踝关节畸形愈合、钢板松动及断裂、骨折复位丢失等并发症发生。结论 与传统L型接骨板相比,新型Pilon钢板治疗C型Pilon骨折具有复位质量高、固定牢靠、对软组织激惹少,以及术后骨折愈合率高、踝关节功能恢Objective By comparing with traditional L-shaped plate, to explore the effectiveness of new Pilon plate in the treatment of type C Pilon fracture. Methods A clinical data of 57 patients with type C Pilon fractures who met the selection criteria between May 2018 and January 2020 was analyzed retrospectively. Thirty-two patients were treated with new Pilon plate(trial group) and 25 patients with traditional L-shaped plate(control group). There was no significant difference in gender, age, cause of injury, fracture side and type, the interval between injury and operation between the two groups(P>0.05). The operation time and complications of the two groups were recorded. X-ray films were taken after operation to assess the quality of fracture reduction according to the Burwell-Charnley classification and fracture healing. Ankle function was evaluated according to Johner-Wruhs scoring standard and American Orthopaedic Foot and Ankle Society(AOFAS) score. Results The operations of the two groups were completed successfully, and the operation time of the trial group was significantly shorter than that of the control group(t=–3.025,P=0.005). After operation, the incision necrosis occurred in 2 cases of the control group, and the incisions of other patients in both groups healed by first intention. All patients were followed up 8-16 months, with an average of 10.1 months. There was no significant difference in follow-up time between the two groups(t=0.433, P=0.667). X-ray films showed that the ankle reduction of the trial group was rated as excellent in 28 cases and good in 4 cases, with an excellent and good rate of100%, while in the control group, the ankle reduction was rated as excellent in 15 cases, good in 5 cases, and fair in 5 cases,with an excellent and good rate of 80.0%. There was a significant difference in the excellent and good rate of fracture reduction between the two groups(Z=–2.565,P=0.010). The fracture healed in both groups, and the healing time was(16.59±3.78) weeks in the trial group and(17.80�

关 键 词：PILON骨折 新型Pilon钢板 踝关节 内固定 

分 类 号：R687.3[医药卫生—骨科学]