延期联合入路三钢板内固定术在Pilon骨折合并腓骨骨折中的应用

来源:用户上传      作者:张萌 李荣俊

　　[摘要] 目的 探延期联合入路三钢板内固定术在Pilon骨折合并腓骨骨折中的应用。 方法 采用前瞻性研究，选取2018年7月至2020年6月间大连大学附属中山医院及大连市第二人民医院骨科收治的108例Pilon骨折合并腓骨骨折患者作为研究对象，采用随机数字表法将其分为对照组和观察组，每组各54例，对照组采用解剖钢板内固定术，观察组采用延期踝关节前后联合入路三钢板内固定术，对两组患者的手术指标、踝关节功能评分、损伤关节面复位进行比较。 结果 观察组患者的手术时间、下床负重时间、住院时间、骨折愈合时间、切口长度明显短于对照组（P<0.001）;观察组术中出血量少于对照组（P<0.001）。观察组患者术后3、6个月的行走、跑动、踝关节稳定性评分、活动评分高于对照组（P<0.001）;观察组患者的损伤关节面复位优良率为94.44%（51/54），高于对照组的68.52%（37/54），差异有统计学意义（P<0.05）。 结论 延期联合入路三钢板内固定术可明显改善Pilon骨折合并腓骨骨折患者手术情况及损伤关节面复位，有助于踝关节功能恢复，预防术后并发症，缩短住院时间，体现了该治疗方案在特殊骨折治疗中的显著优势，值得临床推广实践。
　　[关键词] Pilon骨折;腓骨骨折;骨折固定术;手术情况;踝关节功能评分;复位情况
　　[中图分类号] R683.42 [文献标识码] B [文章编号] 1673-9701（2022）02-0076-04
　　Application of delayed internal fixation with three plates in the treatment of Pilon fracture combined with fractures of fibula
　　ZHANG Meng1 LI Rongjun2
　　1.Department of Orthopaedics， Affiliated Zhongshan Hospital of Dalian University， Dalian 116001， China; 2.Department of Orthopaedics， the Second People′s Hospital of Dalian， Dalian 116011， China
　　[Abstract] Objective To explore the application of delayed internal fixation with three plates in Pilon fracture complicated with fractures of fibula. Methods A prospective study was conducted on 108 patients with Pilon fracture and fibular fracture admitted to the Department of Orthopaedics of Affiliated Zhongshan Hospital of Dalian University and the Second People′s Hospital of Dalian from July 2018 to June 2020 selected as the research objects. They were randomly divided into the control group and the observation group， with 54 cases in each group. The control group was treated with internal fixation with anatomical plate， while the observation group was treated with delayed internal fixation through anteromedial and posterolateral approach of ankle joint with three plates. The operation indexes， scores of ankle joint function and injured articular surface reduction of the two groups were compared. Results The operation time， weight bearing time， hospitalization time， fracture healing time and incision length of the patients in the observation group were significantly shorter than those in the control group （P<0.001）. The amount of bleeding in the observation group was less than that in the control group （P<0.001）. The walk， run， ankle stability scores and activity scores in the observation group at 3 months and 6 months after operation were higher than those the control group （P<0.001）. The excellent and good rate of reduction of injured articular surface in the observation group was 94.44% （51/54）， which was higher than that of 68.52%（37/54） in the control group ， with statistically significant difference （P<0.05）. Conclusion Delayed internal fixation with three plates can significantly improve the operation condition and reduction of injured articular surface of patients with Pilon fracture complicated with fractures of fibula， which is helpful to the recovery of ankle joint function， prevent postoperative complications， and shorten the length of hospital stay. It reflects the significant advantages of this treatment scheme in the treatment of special fractures， and is worthy of clinical practice.
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