摘要【目的】探讨胫骨远端后外侧入路与前内侧入路对Pilon骨折效果及围术期并发症的影响。【方法】选取2018年1月至2021年1月上海市静安区闸北中心医院骨科收治的78例Pilon骨折患者,依照随机数字表法分为观察组和对照组。对照组采用胫骨远端前内侧入路,观察组采用胫骨远端后外侧入路。比较两组基本资料,手术指标,恢复情况及围术期并发症。【结果】观察组患者手术时间较对照组更长、骨折愈合时间较对照组更短,差异均有统计学意义(P<0.05)。术后1个月,观察组视觉模拟疼痛评分(VAS)低于对照组,美国足踝外科协会(AOFAS)踝关节评分高于对照组,差异均有统计学意义(P<0.05)。术后6个月,两组VAS均低于术后1个月,而对照组术后6个月AOFAS踝关节评分高于术后1个月,差异有统计学意义(P<0.05);观察组的总优良率高于对照组(87.18% vs 66.67%,χ2=4.622,P<0.05);两组围术期并发症发生率比较,差异无统计学意义(10.26% vs 17.95%,χ2=0.953,P>0.05)。【结论】与胫骨远端前内侧入路相比,后外侧入路治疗Pilon骨折能够缩短骨折愈合时间,减轻术后疼痛,改善AOFAS踝关节评分,术后关节功能恢复效果好,安全可靠。
Abstract：【Objective】To investigate the effects of distal tibial posterolateral approach and anteromedial approach on Pilon fracture and perioperative complications. 【Methods】A total of 78 patients with Pilon fracture treated in the Department of orthopedics, Zhabei Central Hospital, Jing'an District, Shanghai from January 2018 to January 2021 were randomly divided into observation group and control group. The control group adopted the anteromedial approach of distal tibia, and the observation group adopted the posterolateral approach of distal tibia. The basic data, surgical indexes, recovery and perioperative complications of the two groups were compared. 【Results】The operation time of the observation group was longer and the fracture healing time was shorter than that of the control group (P<0.05). One month after operation, the visual analogue pain score (VAS) of the observation group was lower than that of the control group, and the ankle score of the American foot and ankle surgery association (AOFAS) was higher than that of the control group (P<0.05). At 6 months after operation, the VAS of the two groups was lower than that of 1 month after operation, while the AOFAS ankle score of the control group was higher than that of 1 month after operation (P<0.05); The total excellent rate of the observation group was higher than that of the control group(87.18% vs 66.67%,χ2=4.622,P<0.05);There was no significant difference in the incidence of perioperative complications between the two groups (10.26% vs 17.95%,χ2=0.953,P>0.05).【Conclusion】Compared with the anteromedial approach of the distal tibia, the posterolateral approach in the treatment of Pilon fracture can shorten the fracture healing time, reduce postoperative pain, improve AOFAS ankle score, and have a good effect on the recovery of joint function, which is safe and reliable.
戴杰, 欧阳跃平, 杨柳榭, 李振环. 胫骨远端后外侧入路与前内侧入路治疗Pilon骨折临床疗效比较[J]. 医学临床研究, 2022, 39(3): 359-362.
DAI Jie, OUYANG Yue-ping, YANG Liu-xie, et al. Clinical Comparison of Distal Tibial Posterolateral Approach and Anteromedial Approach in the Treatment of Pilon Fracture. JOURNAL OF CLINICAL RESEARCH, 2022, 39(3): 359-362.
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2022, Vol. 39 
