Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Via Giustiniani 2, 35128 Padova, Italy.
Department of Molecular Medicine (DMM), University of Padua, Via Gabelli 63, 35121 Padova, Italy.
Biomed Res Int. 2018 Mar 1;2018:6054021. doi: 10.1155/2018/6054021. eCollection 2018.
The goal of this retrospective, observational, case series study was to evaluate the medium-long-term clinical and radiographic results of the three most common surgical osteosynthesis techniques used for the treatment of articular tibial pilon fractures: ORIF, MIPO, and EF.
A consecutive series of patients with articular pilon fractures who underwent surgery at our institution were enrolled in this study. Fractures were classified according to the Müller AO classification system. Overall outcomes took the following into account: radiographic quality of reduction, evaluated using Ovadia and Beals' criteria; clinical assessment, evaluated using the AOFAS questionnaire; and general health, evaluated with the SF36-v2 Health Survey.
A total of 94 articular pilon fractures (34 type 43-B and 60 43-C) were evaluated with a mean follow-up of 56.34 months (range 33-101). The techniques used were ORIF, MIPO, and EF in 63 (67%), 17 (18.9%), and 14 cases (14.1%), respectively. According to Ovadia and Beals' criteria, good, fair, and poor results were reported in 61 (64.89%), 26 (27.66%), and 7 (7.45%) cases, respectively. The mean AOFAS score was 82.41 for MIPO, 79.83 for ORIF, and 50.57 for EF, respectively. Thirty-nine patients (41.49%) presented early and/or late complications.
Satisfactory outcomes using the three different techniques were reported. In particular, the radiographic outcomes were inversely proportional to the fracture comminutions and statistically different between internal and external osteosynthesis, but comparable between ORIF and MIPO techniques. On the other hand, the clinical outcomes were closely related to the soft tissue conditions and the anatomical reconstruction of the joint.
本回顾性、观察性、病例系列研究的目的是评估三种最常用于治疗关节胫骨 Pilon 骨折的手术骨内固定技术的中-长期临床和影像学结果：切开复位内固定术（ORIF）、微创经皮内固定术（MIPO）和外固定架（EF）。
连续纳入在我院接受手术治疗的关节 Pilon 骨折患者。骨折根据 Müller AO 分类系统进行分类。总体结果考虑以下因素：使用 Ovadia 和 Beals 标准评估的复位放射学质量；使用 AOFAS 问卷评估的临床评估；使用 SF36-v2 健康调查评估的一般健康状况。
共评估了 94 例关节 Pilon 骨折（34 例 43-B 型和 60 例 43-C 型），平均随访时间为 56.34 个月（范围 33-101 个月）。使用的技术分别为 ORIF、MIPO 和 EF，分别为 63 例（67%）、17 例（18.9%）和 14 例（14.1%）。根据 Ovadia 和 Beals 标准，分别报告了 61 例（64.89%）、26 例（27.66%）和 7 例（7.45%）的良好、一般和差的结果。MIPO、ORIF 和 EF 的平均 AOFAS 评分为 82.41、79.83 和 50.57。39 例（41.49%）患者出现早期和/或晚期并发症。
报告了使用三种不同技术的满意结果。特别是，放射学结果与骨折粉碎程度呈反比，内固定和外固定之间的统计学差异，并与 ORIF 和 MIPO 技术之间的可比性。另一方面，临床结果与软组织状况和关节解剖重建密切相关。
