锁定加压钢板与解剖钢板内固定修复Pilon骨折的比较

背景：解剖钢板作为传统的内固定方法仍有诸多不足，近年来锁定钢板内固定也开始被广泛应用于Pilon 骨折治疗中，如何在有效重建胫骨远端关节面的同时尽量减少软组织的进一步损伤正逐渐被越来越多的骨科医师所重视。目的：对比观察锁定加压钢板与解剖钢板置入内固定对Pilon骨折患者的修复效果。   方法：回顾性分析2010年1月至2014年8月在佛山市三水区人民医院接受治疗的Ruedi-Allgower Ⅱ、Ⅲ型Pilon骨折患者72例，按随机数字表法分为两组，其中36例观察组患者采用锁定加压钢板置入内固定治疗，36例对照组患者采用解剖钢板置入内固定治疗，比较两组患者的平均手术时间、平均内固定后恢复时间及并发症发生率，出院后随访两组患者的临床修复效果和内固定后骨折复位情况。结果与结论：两组平均手术时间、平均术后恢复时间相比，观察组优于对照组，差异有显著性意义(P <0.05)；在术后并发症方面，延迟愈合与不愈合例数观察组少于对照组；观察组内固定后恢复优者26例，对照组22例，两组比较观察组优于对照组；在内固定后恢复的放射学评价结果方面，观察组与对照组差异无显著性意义(P > 0.05)。提示相对于解剖钢板，锁定加压钢板置入修复Pilon骨折能缩短手术时间以及患者内固定后恢复时间，减少内固定后不愈合与延迟愈合的发生率，并在一定程度上提高修复效果。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程全文链接：

Comparison of locking compression plate and anatomic plate internal fixation for Pilon fracture

BACKGROUND: As a conventional internal fixation method, anatomic plate has some shortcomings. Recently locking plate has been widely used in treatment of Pilon fracture. How to effective reconstruct articular facet at the distal tibia and to reduce soft tissue damage have attracted increasing attentions.OBJECTIVE: To compare the curative effect of locking compression plate versus anatomic plate internal fixation in treatment of Pilon fracture.METHODS:A retrospective analysis was performed among 72 patients of Ruedi-Allgower II and III Pilon fracture, who were selected from Sanshui People’s Hospital of Foshan between January 2010 and August 2014. The involved patients were randomly divided into two groups: 36 patients of observation group were treated with locking compression plate internal fixation, and 36 patients of control group were given anatomic plate internal  fixation. The average operation time, postoperative recovery time, postoperative complications, curative effect and postoperative fracture situation were compared between the two groups. RESULTS AND CONCLUSION:The average operation time and the average postoperative recovery time of observation group were significantly better than that of control group (P < 0.05). In terms of postoperative complications, there were less cases of delayed healing and non-union in the observation group than in the control group. 26 cases of observation group and 22 cases of control group recovered well after internal fixation, observation group was better than control group. There was no significant difference in the radiological evaluation results of postoperative recovery between the two groups (P > 0.05). Compared with the anatomic plate internal fixation, locking compression plate internal fixation can shorten the operation time and postoperative recovery time, reduce the incidence of delayed healing and nonunion after internal fixation, and improve clinical curative effect in treatment of Pilon fracture.