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Pilon骨折定义为胫骨远端1/3并且累及干骺端和胫距关节面的骨折,发病率约占下肢骨折的1%,胫骨远端骨折的7%。Pilon骨折多为高能量损伤,且因胫骨远端软组织覆盖较少,术后容易发生如切口坏死感染、内固定物外露等严重并发症[1],故如何更好的治疗Pilon骨折得到了外科医生的广泛关注。Pilon骨折的治疗方法多种多样,包括保守治疗和手术治疗等,手术治疗方法包括外固定架、髓内钉、接骨板等,均各有其优缺点,因此对于Pilon骨折,哪种治疗方法更好,并未达成共识。关于Pilon骨折的手术入路的选择,传统的内外侧双切口仍然是主流,但随着对Pilon骨折的进一步的研究认识和胫骨前外侧钢板的研究应用,胫前外侧入路逐渐被广大学者认识和研究[2],胫前外侧入路的优势在于:(1)可以很好的暴露胫骨的下关节面,特别是下胫腓联合、前踝及关节面的前外侧的Chaput骨块,能够在直视下复位关节面,利于骨折的复位;(2)前外侧入路可更好的保护软组织,减少软组织剥离,同时降低腓浅神经损伤的可能性[3];(3)单一切口同时处理胫骨和腓骨骨折,简化了手术流程。但目前Pilon骨折前外侧入路的研究仍相对较少。基于此优势,我们连续对28例Pilon骨折病人分别采用前外侧入路及内外侧入路治疗,对比分析胫前外侧入路与内外侧入路治疗Pilon骨折的手术相关指标、疗效及安全性等。
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2组病人解剖复位率、手术时间、骨折愈合时间差异均无统计学意义(P>0.05)。A组切口长度明显短于B组,术中出血量、术后引流量均明显低于B组,(P < 0.01)(见表 1、2)。
分组 n 解剖复位 复位一般 复位差 解剖复位率/% χ2 P A组 14 9 5 0 64.3 B组 14 6 7 1 42.9 1.29 >0.05 合计 28 15 12 1 53.6 表 1 2组病人骨折复位情况比较
分组 n 切口长度/cm 手术时间/min 术中出血/mL 术后引流量/mL 骨折愈合时间/周 A组 14 11.2±1.5 70.5±19.3 82.1±15.5 130.1±15.4 15.5±1.8 B组 14 20.6±4.6 74.4±21.4 105.3±16.8 180.3±20.6 16.2±2.0 t — 7.27* 0.51 3.80 7.30 0.97 P — <0.01 >0.05 <0.01 <0.01 >0.05 *示t′值 表 2 2组病人手术情况及骨折愈合情况比较(x±s)
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28例病人随诊4~18(7.5±1.7)个月,骨折均获得愈合,其中A组发生术后切口感染1例,关节强直1例;B组发生切口感染5例,创伤性关节炎1例。2组病人关节功能优良率及并发症发生率差异均无统计学意义(P>0.05)。A组病人Barid-Jackson评分明显高于B组,差异有统计学意义(P < 0.01)(见表 3)。
分组 n 关节功能 Barid-Jackson评分(x±s) 术后并发症[n(%)] 优 良 可 差 优良率/% A组 14 7 5 2 0 85.7 91.64±1.10 2(14.2) B组 14 6 4 3 1 71.4 85.59±2.24 6(42.8) χ2 — — — — — 0.85 9.07* 1.58 P — — — — — >0.05 <0.01 >0.05 *示t′值 表 3 2组病人临床疗效及并发症发生情况比较
经胫前外侧入路切口在治疗Pilon骨折中的应用
Application value of the anterolateral tibial approach in the treatment of Pilon fracture
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摘要:
目的探讨经胫前外侧入路治疗Pilon骨折的临床疗效。 方法将Pilon骨折病人28例随机分为胫前外侧入路组(A组)与传统内外侧入路组(B组),每组14例。随访并分析比较病人切口长度、手术时间、术中出血量、术后引流量、骨折愈合时间、骨折复位情况、术后并发症情况、术后踝关节功能等指标以评价疗效。 结果2组病人解剖复位率、手术时间、骨折愈合时间差异均无统计学意义(P>0.05);但A组切口长度明显短于B组,术中出血、术后引流量均明显低于B组(P < 0.01)。2组病人关节功能优良率及并发症发生率差异均无统计学意义(P>0.05);但A组病人Barid-Jackson评分明显高于B组(P < 0.01)。 结论经胫前外侧入路治疗关节面内侧严重粉碎塌陷以外类型的Pilon骨折,能取得满意的疗效,优于传统内外侧入路,可促进病人尽快康复。 Abstract:ObjectiveTo evaluate the clinical effects of the anterolateral tibial approach in the treatment of Pilon fracture. MethodsA total of 28 patients with Pilon fracture were randomly divided into the anterior lateral approach group(group A) and traditional medial approach group(group B)(14 cases each group).The incision length, operation time, intraoperative blood loss, postoperative drainage, fracture healing time, fracture reduction, postoperative complications and postoperative ankle function between two groups were compared. ResultsThe differences of the anatomical reduction rate, operation time and fracture healing time between two groups were not statistically significant(P>0.05).The incision length in group A was significantly shorter than that in group B, and the intraoperative bleeding and postoperative drainage volume in group A were significantly lower than those in group B(P < 0.01).The differences of the excellent rate of joint function and incidence rate of complications between two groups were not statistically significant(P>0.05).The Barid-Jackson score in group A was significantly higher than that in group B(P < 0.01). ConclusionsThe anterolateral tibial approach in the treatment of Pilon fracture except to severe crushing and collapse of the inner side of the articular surface can achieve satisfactory efficacy and promote the patients to recover as soon as possible, which is superior to the traditional medial and lateral approach. -
Key words:
- Pilon fracture /
- approach /
- anterolateral approach /
- internal and external approach
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表 1 2组病人骨折复位情况比较
分组 n 解剖复位 复位一般 复位差 解剖复位率/% χ2 P A组 14 9 5 0 64.3 B组 14 6 7 1 42.9 1.29 >0.05 合计 28 15 12 1 53.6 表 2 2组病人手术情况及骨折愈合情况比较(x±s)
分组 n 切口长度/cm 手术时间/min 术中出血/mL 术后引流量/mL 骨折愈合时间/周 A组 14 11.2±1.5 70.5±19.3 82.1±15.5 130.1±15.4 15.5±1.8 B组 14 20.6±4.6 74.4±21.4 105.3±16.8 180.3±20.6 16.2±2.0 t — 7.27* 0.51 3.80 7.30 0.97 P — <0.01 >0.05 <0.01 <0.01 >0.05 *示t′值 表 3 2组病人临床疗效及并发症发生情况比较
分组 n 关节功能 Barid-Jackson评分(x±s) 术后并发症[n(%)] 优 良 可 差 优良率/% A组 14 7 5 2 0 85.7 91.64±1.10 2(14.2) B组 14 6 4 3 1 71.4 85.59±2.24 6(42.8) χ2 — — — — — 0.85 9.07* 1.58 P — — — — — >0.05 <0.01 >0.05 *示t′值 -
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