摘要
目的:探讨经后外侧入路支撑钢板与后向前拉力螺钉内固定治疗KlammerⅠ型后pilon骨折的疗效差异。方法:纳入2014年6月至2020年12月行手术治疗的KlammerⅠ型后pilon骨折患者29例。依骨折内固定方式,分为后侧支撑钢板组(钢板组,17例)和后向前拉力螺钉组(螺钉组,12例)。记录骨折愈合情况及术后并发症,末次随访采用美国足踝外科医师协会(AOFAS)评分评估踝关节功能,疼痛视觉模拟评分(VAS)评分评估静息与活动时踝关节疼痛,Burwell-Charnley评分评估骨折复位情况。结果:钢板组手术时间长于螺钉组[(112±20)min vs.(98±17)min,P=0.004]。所有患者随访过程中骨折均愈合,无不愈合、延期愈合,钢板组与螺钉组随访时间[(26.0±6.5)个月vs.(23.1±10.2)个月,P=0.335]及骨折愈合时间[(14.2±2.0)周vs.(14.8±1.8)周,P=0.392]差异无统计学意义。术后钢板组出现后外侧伤口浅表坏死1例,踝关节慢性疼痛1例。螺钉组出现螺钉过长刺激踝前方软组织1例,后外侧切口局部麻木感1例。末次随访静息时钢板组VAS评分(0.4±0.7)分,螺钉组(0.2±0.5)分;活动时钢板组VAS评分(0.5±0.9)分,螺钉组(0.8±1.1)分;静息与活动时两组VAS评分差异均无统计学意义。末次随访钢板组AOFAS评分优于螺钉组[(89.0±6.2)分vs.(83.8±5.0)分,P=0.018]。依据Burwell-Charnley评分系统,钢板组解剖复位17例;螺钉组解剖复位10例,可2例。结论:对于KlammerⅠ型后pilon骨折患者,后侧支撑钢板与后向前拉力螺钉均可有效固定,并获得良好功能恢复。螺钉固定不增加术后并发症风险,且缩短手术时间;钢板固定与后向前拉力螺钉固定相比远期功能恢复更佳。
Objective: To investigate the difference of curative effect between buttress plate and posteroanterior screw in the treatment of Klammer type Ⅰ posterior pilon fracture. Methods: Twenty-nine patients with Klammer type Ⅰ posterior pilon fracture who underwent surgical treatment in our hospital from June 2014 to December 2020 were enrolled. According to the internal fixation methods, the patients were divided into two groups: the buttress plate group(BP group, n=17) and the posteroanterior screw group(PAS group, n=12). The bone healing time and postoperative complications were recorded. The ankle function was evaluated by AOFAS score, the ankle pain was evaluated by VAS score during rest and exercise, and the fracture reduction was evaluated by Burwell-Charnley score. Results: The operation time was longer in BP group than in PAS group [(112.3±20.1) min vs.(98.4±16.5) min, P=0.004]. All fractures were healed during the follow-up without nonunion or delayed healing. There was no significant difference in the follow-up time [(26.0±6.5) months vs.(23.1±10.2) months, P=0.335] and bone healing time [(14.2±2.0) weeks vs.(14.8±1.8) weeks, P=0.392) between the two groups. In postoperative BP group one patient occurred superficial necrosis of posterolateral wound and one patient had chronic pain of ankle. In PAS group, one patient had excessive screw stimulation to soft tissue in front of ankle, and one patient had local numbness in posterolateral incision. At the last follow-up, the VAS scores of the two groups at rest were(0.4±0.7) in BP group and(0.2±0.5) in PAS group respectively;the VAS scores of the two groups during exercise were(0.5±0.9) in BP group and(0.8±1.1) in PAS group. There was no significant difference in VAS scores between the two groups at rest and during exercise(P>0.05). The AOFAS score in BP group was better than that in PAS group [(89.0±6.2) vs.(83.8±5.0), P=0.018]. According to Burwell-Charnley scoring system, 17 patients in BP group were reducted anatomically and in PAS group anatomi
作者
张琳袁
吴佳俊
李卓凯
沈超
王跃挺
刘凤祥
王秀会
ZHANG Linyuan;WU Jiajun;LI Zhuokai;SHEN Chao;WANG Yueting;LIU Fengxiang;WANG Xiuhui(Department of Orthopaedics,Shanghai university of Medicine&Health Sciences Affiliated Zhoupu Hospital,Shanghai 201318;Shanghai Key Laboratory of Orthopaedic Implant,Department of Orthopaedics,Shanghai Ninth People's Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200011,China)
出处
《中华骨与关节外科杂志》
2022年第8期626-632,共7页
Chinese Journal of Bone and Joint Surgery
基金
上海市医学重点专科建设基金(ZK2019B05)
上海市自然科学基金(18ZR1422000)
浦东新区卫健委临床特色学科项目(PWYts2021-03)。
关键词
后pilon骨折
内固定
支撑钢板
螺钉
比较研究
Posterior Pilon Fracture
Internal Fixation
Buttress Plate
Screw
Comparative study
