两种骨折分型指导Pilon骨折切开复位内固定比较  

Open reduction and internal fixation based on comprehensive classification versus AO classification for pilon fractures

作　　者：王智祥 魏世隽[2] 蔡贤华 WANG Zhi-xiang;WEI Shi-jun;CAI Xian-hua(Department of Bone and Joint Surgery,First Hospital of Wuhan City,Wuhan 430022,Hubei,China;Department of Orthopedics,General Hospital,Central Theater of PLA,Wuhan 430070,Hubei,China;Department of Orthopedics,South China Hospital,Shenzhen University,Shenzhen Guangdong 518111,China)

机构地区：[1]武汉市第一医院骨关节外科,湖北武汉430022 [2]中国人民解放军武汉总医院骨科,湖北武汉430070 [3]深圳大学附属华南医院骨科,广东深圳518111

出　　处：《中国矫形外科杂志》2024年第18期1640-1646,共7页Orthopedic Journal of China

摘　　要：[目的]比较基于综合法分型开放复位内固定(open reduction and internal fixation,ORIF)与基于AO分型ORIF治疗Pilon骨折的临床疗效,为临床治疗方案的制定提供参考。[方法]回顾性分析2017年6月-2019年10月收治且获得随访的90例Pilon骨折患者的临床资料。根据术前医患沟通结果,将患者分为两组,45例采用基于综合法分型的ORIF(综合组),另外45例采用基于AO分型的ORIF(AO组)。比较两组围手术期、随访及影像结果。[结果]综合组在切口总长度[(13.2±1.5)cm vs(13.8±1.0)cm,P=0.018]、术中失血量[(50.9±18.4)ml vs(63.8±17.6)ml,P<0.001]、住院时间[(13.4±3.6)d vs(16.2±5.6)d,P=0.006]均显著优于AO组。随访时间平均(18.5±4.6)个月。综合组完全负重活动时间显著早于AO组[(84.4±6.1)d vs(87.3±7.4)d,P=0.046]。随时间推移两组踝背伸-跖屈ROM、VAS评分、AOFAS评分均显著改善(P<0.05),术后相应时间点,综合组上述指标均显著优于AO组(P<0.05)。影像方面,综合组骨折复位质量显著优于AO组[优/良/差,(17/22/6)例vs(12/16/17)例,P=0.029]。与术前相比,末次随访时,两组踝穴高度、宽度、冠状角、矢状角均显著改善(P<0.05)。末次随访时,综合组踝穴高度[(23.2±2.5)mm vs(24.3±2.5)mm,P=0.044]、宽度[(39.9±2.3)mm vs(41.8±2.9)mm,P<0.001]、冠状角[(6.4±1.1)°vs(6.9±1.0)°,P=0.044]、矢状角[(13.0±1.3)°vs(13.7±1.6)°,P=0.030]均显著优于AO组。[结论]基于综合法分型的ORIF临床结果显著优于基于AO分型的ORIF,提示综合法分型指导ORIF具有重要临床意义。[Objective]To compare the clinical efficacy of open reduction and internal fixation(ORIF)based on comprehensive classification versus ORIF based on AO classification for pilon fractures,and to provide a reference for the surgical plan making.[Methods]A retrospective study was conducted on 90 patients who received ORIF for pilon fractures from June 2017 to October 2019.According to the preoperative doctor-patient communication,the patients were divided into two groups.Of them,45 patients had ORIF performed based on comprehensive classification(the comprehensive group),while other 45 patients had operation conducted based on the traditional AO classification(the AO group).The documents of perioperative period,follow-up and images were compared between the two groups.[Results]The comprehensive group proved significantly superior to the AO group in terms of incision length[(13.2±1.5)cm vs(13.8±1.0)cm,P=0.018],intraoperative blood loss[(50.9±18.4)ml vs(63.8±17.6)ml,P<0.001]and hospital stay[(13.4±3.6)days vs(16.2±5.6)days,P=0.006].The average follow-up time was of(18.5±4.6)months,and the comprehensive group resumed full weight-bearing activity significantly earlier than the AO group[(84.4±6.1)days vs(87.3±7.4)days,P=0.046].The ROM,VAS scores and AOFAS scores in both groups were significantly improved over time(P<0.05),which in the comprehensive group were significantly better than those in the AO group at all corresponding time points after surgery(P<0.05).With respect of imaging,fracture reduction quality in the comprehensive group was significantly better than that in the AO group[excellent/good/poor,(17/22/6)vs(12/16/17),P=0.029].Compared with those preoperatively,the height,width,coronal angle and sagittal angle of ankle mortise in both groups were significantly improved at the last follow-up(P<0.05).At the last follow-up,the comprehensive group proved significantly better than the AO group regarding to the height[(23.2±2.5)mm vs(24.3±2.5)mm,P=0.044],width[(39.9±2.3)mm vs(41.8±2.9)mm,P<0.001],coronary

关 键 词：PILON 骨折 综合法分型 AO 分型 开放复位内固定 临床结果 

分 类 号：R683.42[医药卫生—骨科学]