仰卧位改良后内侧入路联合前外侧入路治疗后pilon骨折的疗效分析  

Modified posteromedial approach combined with anterolateral approach for treatment of posterior pilon fracture in supine position

作　　者：郭常军[1] 李星辰[1] 杨崇林[1] 李春光 徐向阳[1] Guo Changjun;Li Xingchen;Yang Chonglin;Li Chunguang;Xu Xiangyang(Department of Orthopedics,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院骨科,上海200025

出　　处：《中华创伤骨科杂志》2023年第11期936-943,共8页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨仰卧位改良后内侧入路联合前外侧入路治疗后pilon骨折的疗效。方法回顾性分析2016年1月至2020年12月于上海交通大学医学院附属瑞金医院骨科接受手术治疗的54例后pilon骨折患者资料。男45例,女9例;年龄(47.7±13.1)岁。根据手术体位不同分为2组:仰卧组24例(采用仰卧位改良后内侧入路联合前外侧入路)和俯卧组30例(采用俯卧位后内侧入路联合后外侧入路)。比较两组患者的手术时间、住院时间和影像学结果(包括骨愈合时间和关节面复位优良率)、踝关节活动范围和术后并发症发生情况。使用疼痛视觉模拟评分(VAS)和曼彻斯特牛津足部评分(MOXFQ)评估疗效。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。仰卧组和俯卧组患者的术后随访时间分别为(19.4±4.4)、(17.8±4.2)个月。仰卧组患者的手术时间、住院时间、骨愈合时间、下胫腓联合固定率和关节面复位优良率分别为(90.8±9.9)min、(9.5±2.4)d、(8.4±1.4)周、33.3%(8/24)和95.8%(23/24),俯卧组为(89.9±10.8)min、(9.5±2.5)d、(8.1±1.4)周、53.3%(16/30)和96.6%(29/30),以上项目两组间比较差异均无统计学意义(P>0.05)。末次随访时仰卧组患者的踝关节背伸活动度、跖屈活动度、VAS及MOXFQ疼痛评分、行走能力评分、社交能力评分分别为15.0°±2.1°、26.1°±4.2°、(1.0±0.5)分、20.0(0,30.0)分、(16.5±13.2)分、12.5(0,18.8)分,俯卧位组为15.7°±1.6°、27.0°±4.0°、(1.3±0.7)分、12.5(10.0,30.0)分、(19.0±11.5)分、15.6(6.3,25.0)分,以上项目两组间比较差异均无统计学意义(P>0.05)。仰卧组患者的总并发症发生率为8.3%(2/24),俯卧组为3.3%(1/30),差异无统计学意义(P>0.05)。结论仰卧位改良后内侧入路联合前外侧入路治疗后pilon骨折与俯卧位后内侧入路联合后外侧入路疗效相当,可作为治疗后pilon骨折的一种入路选择。Objective To investigate the clinical effects of the modified posteromedial approach combined with the anterolateral approach in the treatment of posterior pilon fractures in the supine position.Methods A retrospective was conducted to analyze the clinical data of 54 patients[45 males and 9 females with an age of(47.7±13.1)years]who had been treated surgically for posterior pilon fractures from January 2016 to December 2020 at Department of Orthopedics,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.The patients were divided into 2 groups according to their surgical positions:a supine group of 24 patients(the modified posteromedial approach combined with the anterolateral approach in the supine position)and a prone group of 30 patients(the posteromedial approach combined with the anterolateral approach in the prone position).The 2 groups were compared in terms of operation time,hospitalization time,radiographic outcomes(bone union time and ratio of congruent articular reduction),range of ankle motion,and postoperative complications.The post-operative function was evaluated using the Manchester Oxford Foot Questionnaire(MOXFQ)and the visual analogue scale(VAS).Results There was no statistically significant difference between the 2 groups in the general clinical data before operation,showing comparability(P>0.05).The mean follow-up time was(19.4±4.4)months for the supine group and(17.8±4.2)months for the prone group.The operation time,hospitalization time,bone union time,rate of fixation of syndesmosis and ratio of congruent articular reduction were(90.8±9.9)min,(9.5±2.4)d,(8.4±1.4)weeks,33.3%(8/24)and 95.8%(23/24)in the supine group,and(89.1±10.8)min,(9.5±2.5)d,(8.1±1.4)weeks,53.3%(16/30)and 96.6%(29/30)in the prone group,showing no significant differences(all P>0.05).At the last follow-up,the dorsiflexion and plantar flexion of the ankle,VAS,and MOXFQ scores for pain,walking and social capability were,respectively,15.0°±2.1°,26.1°±4.2°,(1.0±0.5)points,20.0(0,30.0)poi

关 键 词：踝关节 仰卧位 俯卧位 后pilon骨折 改良后内侧入路 

分 类 号：R687.3[医药卫生—骨科学]