Barış Alican, Çirci Esra, Demirci Ziya, Öztürkmen Yusuf
Department of Orthopedics and Traumatology, İstanbul Training and Research Hospital, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2020 Jan;54(1):20-26. doi: 10.5152/j.aott.2020.01.489.
The aim of this study was to evaluate the long-term follow-up and functional and radiological outcomes of minimally invasive medial plate osteosynthesis in distal tibia fractures.
From January 2011 to November 2015, we reviewed the medical records of 60 patients with 62 tibia fractures (41 men and 19 women; mean age: 45.3±14.9 years) who were treated with open reduction and internal fixation for distal tibia pilon fractures. The mean follow-up time after surgery was 42.7±4.6 months. Union time, coronal plan deformity, complication rates and AOFAS and Olerud-Molander functional outcome scores were evaluated.
According to the AO/OTA classification, there were thirty four (54.8%) type 43-A fracture, eight (12.9%) type 43-B fractures, twenty (32.3%) type 43-C fractures. The average time for fracture union was 16.1 weeks. The mean AOFAS score was 86.6±9.1. The mean Olerud-Molander score was 85.6±9.8. There were four patients (6.5%) with a varus of less than 5°, two patients (3.2%) with a valgus of less than 5°, 39 patients (62.9%) with recurvatum (34 of them less than 5°; five of them less than 10°), and 14 patients (22.6%) with procurvatum (12 of them less than 5°; two of them less than 10°). The AOFAS and Olerud-Molander scores in the smoker and diabetic patients were significantly lower than the non-smoker (p=0.002; p=0.005) and non-diabetic patients (p=0.022, p=0.002). The duration of union was significantly higher in both diabetic (p=0.025) and smoker patients (p=0.041). There was no association between the fracture type and the presence of varus, valgus, recurvatum and rotation deformity. The AOFAS score, Olerud-Molander score and plantar-flexion were significantly higher in type A fractures than in type C fractures (p=0.021; p=0.030, and p=0.033, respectively). AOFAS score, Olerud-Molander score, plantar-flexion value did not differ between type B and type C fractures. There was no significant difference among the dorsi-flexion (p=0.211), the follow-up time (p=0.531) and duration of union (p=0.908) of type A, type B and type C fractures. Three patients with open fracture had delayed wound healing. One patient developed skin necrosis. They were treated by local wound care.
Minimally invasive medial plate osteosynthesis is a reliable method of treatment for tibial pilon fractures. This technique provides a high fracture healing rate and satisfying functional outcome with minimal wound healing complications. Sagittal plan deformity remains a common complication with minimally invasive medial plate osteosynthesis.
Level IV, Therapeutic Study.
本研究旨在评估微创内侧钢板接骨术治疗胫骨远端骨折的长期随访结果以及功能和影像学结局。
回顾2011年1月至2015年11月间60例（共62处胫骨骨折）接受切开复位内固定治疗的胫骨pilon骨折患者的病历记录。其中男性41例，女性19例；平均年龄：45.3±14.9岁。术后平均随访时间为42.7±4.6个月。评估骨折愈合时间、冠状面畸形、并发症发生率以及美国足踝外科协会（AOFAS）和奥勒鲁德 - 莫兰德（Olerud-Molander）功能结局评分。
根据AO/OTA分类，43 - A型骨折34例（54.8%），43 - B型骨折8例（12.9%），43 - C型骨折20例（32.3%）。骨折平均愈合时间为16.1周。AOFAS平均评分为86.6±9.1。Olerud-Molander平均评分为85.6±9.8。内翻小于5°的患者有4例（6.5%），外翻小于5°的患者有2例（3.2%），膝反屈患者39例（62.9%）（其中34例小于5°；5例小于10°），前凸患者14例（22.6%）（其中12例小于5°；2例小于10°）。吸烟患者和糖尿病患者的AOFAS及Olerud-Molander评分显著低于非吸烟患者（p = 0.002；p = 0.005）和非糖尿病患者（p = 0.022，p = 0.002）。糖尿病患者（p = 0.025）和吸烟患者（p = 0.041）的骨折愈合时间均显著延长。骨折类型与内翻、外翻、膝反屈及旋转畸形的发生无相关性。A型骨折的AOFAS评分、Olerud-Molander评分及跖屈功能显著高于C型骨折（分别为p = 0.021；p = 0.030，p = 0.033）。B型与C型骨折之间的AOFAS评分、Olerud-Molander评分及跖屈值无差异。A型、B型和C型骨折在背屈（p = 0.211）、随访时间（p = 0.531）及骨折愈合时间（p = 0.908）方面无显著差异。3例开放性骨折患者出现伤口愈合延迟。1例患者发生皮肤坏死。均经局部伤口护理治疗。
微创内侧钢板接骨术是治疗胫骨pilon骨折的可靠方法。该技术骨折愈合率高，功能结局满意，伤口愈合并发症少。矢状面畸形仍是微创内侧钢板接骨术常见的并发症。
四级，治疗性研究。
