基于CT断层扫描的手术入路策略在复杂胫骨后Pilon骨折切开复位内固定中的应用

黄彬 徐祖旺 吴帆 周重刚 吕隋本 余学文 李昌杰 汪洋

【摘要】 目的：探討基于CT断层扫描的手术入路策略在复杂胫骨后Pilon骨折切开复位内固定中的应用效果。方法：选择2018年4月-2020年9月本院收治的复杂胫骨后Pilon骨折患者114例为研究对象，按照随机数字表法分为两组，每组57例。对照组采用前外侧入路手术治疗，观察组采用基于CT断层扫描的手术入路策略的切开复位固定术治疗，术后14 d对两组效果进行评估，比较两组手术指标、Mazur评分、AOFAS评分、VAS评分、踝关节活动变化及并发症。结果：两组手术时间、手术费用比较，差异均无统计学意义（P>0.05）;观察组骨折愈合时间、术后首次下地活动时间均短于对照组，术中出血量少于对照组（P<0.05）;观察组术后14 d的Mazur评分、AOFAS评分及踝关节活动度均高于对照组，VAS评分低于对照组（P<0.05）;观察组术后并发症发生率均低于对照组（P<0.05）;观察组术后14 d的SF-36量表各维度评分均高于对照组（P<0.05）。结论：基于CT断层扫描的手术入路策略的切开复位内固定术用于复杂胫骨后Pilon骨折患者中手术创伤较小，可改善患者踝关节功能，降低术后并发症发生率，值得推广应用。

【关键词】 CT断层扫描 复杂胫骨后Pilon骨折 切开复位 内固定

Surgical Approach Strategy Based on CT Tomography in Open Reduction and Internal Fixation of Complex Posterior Tibial Pilon Fractures/HUANG Bin， XU Zuwang， WU Fan， ZHOU Chonggang， LYU Suiben， YU Xuewen， LI Changjie， WANG Yang. //Medical Innovation of China， 2021， 18（31）： 0-066

[Abstract] Objective： To investigate the application effect of surgical approach strategy based on CT tomography in open reduction and internal fixation of complex posterior tibial Pilon fractures. Method： A total of 114 patients with complex posterior tibial Pilon fractures treated in our hospital from April 2018 to September 2020 were selected as subjects and randomly divided into two groups by random number table method， 57 patients in each group. The control group was treated by anterolateral surgical approach treatment， the observation group was treated by surgical approach strategy based on CT tomography in open reduction and internal fixation， 14 d after surgery to evaluate effect of patients， the operation indicators， Mazur score， AOFAS score， VAS score， ankle activity changes and complications of two groups were compared. Result： There were no statistical significances in operation time and operation cost between two groups （P>0.05）. Compared with the control group， the observation group had shorter fracture healing， first postoperative movement time and lower intraoperative blood loss （P<0.05）. 14 d after surgery， Mazur score， AOFAS score and range of motion of ankle in the observation group were higher than those in the control group， VAS score was lower than that in the control group （P<0.05）. The incidence of postoperative complications in the observation group was lower than that in the control group （P<0.05）. The scores of SF-36 scale in the observation group at 14 d after surgery were higher than those in the control group （P<0.05）. Conclusion： Surgical approach strategy based on CT tomography in open reduction and internal fixationcan be used in patients with complex posterior tibial Pilon fractures， improve the function of patient’s ankle joint， and reduce the incidence of postoperative complications， which is worth promoting and applying.

[Key words] CT tomography Complex posterior tibial Pilon fractures Open reduction Internal fixation

First-author’s address： Jiujiang Traditional Chinese Medicine Hospital， Jiujiang 332000， China

doi：10.3969/j.issn.1674-4985.2021.31.015

复杂胫骨后Pilon骨折临床上并无明确的定义，是指累及胫距关节面的胫骨远端骨折，多发生在高处坠落、车祸骤停、滑雪或绊脚前摔患者中[1]。李晓国等[2]研究表明复杂胫骨后Pilon骨折应包括踝关节和胫骨远端的干骺端骨折、内踝骨折、胫骨前缘骨折及胫骨后面横行骨折。……