| Part One Clinical study of closed reduction using double-reverse traction reduction device combined with minimally invasive treatment of Pilon fracture of tibia with percutaneous plate implantationObjective: In this study,the double inverse traction repository(DRTR)combined with minimally invasive plate osteosynthesis(MIPO)in the surgical treatment of piloli fracture was introduced,and the efficiency in the short term follow-up was observed.Methods: From March to September 2018,patients with pilon fractures who were treatment by MIPO with DRTR were reviewed.The demographic and fracture characteristics,surgical data,and prognostic data of 15 patients were extracted.Results: In all 15 cases closed reduction was achieved with MIPO technique and excellent functional and radiological outcomes were observed.The average duration of surgery and intraoperative blood loss were 100 ± 13.8mins and 153.3 ± 58.1 ml,respectively.And a mean 16.3 ± 2.2 times intraoperative fluoroscopy were shown.At 12-month follow-up,the average AOFAS scores were 84.5 ± 6.0.Anatomic or good reduction was observed in14(93.3%)cases.The mean range of motion of dorsiflexion and plantarflexion were 10.5 ± 3.2 and 30.1 ± 4.3,respectively.One case of deep venous thrombosis and one wound non-purulent exudate was observed.And the wound healed after routine dressing change.None skin necrosis,delayed,non-or malunion,and traumatic osteoarthritis was observed.Conclusions: The new strategy combined DRTR with MIPO in the treatment of pilon fractures allowed to achieve excellent radiological and clinical outcomes and a low postoperative complications rate in short-term follow up.Further large sample and comparative study should be conducted to validate our results.Part Two Finite element analysis of two fixation methods in the treatment of tibial Pilon fractureObjective: To investigate the biomechanical characteristics of medial tibial anatomical plate and anterolateral tibial anatomical plate in the treatment of tibial Pilon fracture.Methods: the ankle CT data of healthy adults were selected as the research object.The fracture model and internal fixation model were established by using Mimics software,and the finite element analysis was carried out to compare the comprehensive displacement of the fracture block and internal fixation under axial load,as well as the maximum stress borne by the fracture block and internal fixation,so as to provide scientific reference for orthopedics doctors in the selection of internal fixation in the treatment of tibial Pilon fracture.Results: under the fixed axial load,the comprehensive displacement of the fracture block fixed by the medial tibial plate was 0.975 mm,which was less than that of the anterolateral tibial plate by 1.076mm;The comprehensive displacement of the inner steel plate(1.178mm)is less than that of the front outer steel plate(1.224mm).The maximum stress of tibial medial plate fixed fracture block is 142.3mpa,which is less than 227.6mpa.The maximum stress borne by the inner steel plate is 110.7mpa,which is less than the maximum stress borne by the front outer steel plate of 112.1mpa.Conclusions: the biomechanical characteristics of medial tibial plate fixation in the treatment of tibial Pilon fracture are better than that of anterior medial tibial plate.If the soft tissue conditions permit,medial tibial plate fixation can be preferred in the treatment of tibial Pilon fracture.Part Three Comparative study on clinical efficacy of two surgical methods in the treatment of ankle fractureObjective: To compare the clinical effects of closed reduction minimally invasive surgery and open reduction internal fixation in the treatment of ankle fractures.Methods: From July 2016 to July 2018,the data of 60 patients with ankle fractures who were hospitalized and treated surgically in our hospital were retrospectively analyzed.There were 29 cases of closed minimally invasive surgery(experimental group)and 31 cases of open type internal fixation(control group)by different operation methods.Operative time,intraoperative blood loss,intraoperative view time,postoperative Burwell Charnley Radiation Evaluation,Postoperative complications and ankle joint function of 2 groups were collected and compared.Results: There was no significant difference between the experimental and control groups(P > 0.05),and the two groups were equivalent.All patients were followed up for 12～18 months(average 16.5 months),and 60 patients got bony union.The operation time of the experimental group was(42.9±2.5min)shorter than that of the control group(82.6±5.3min).The amount of bleeding(21.4±5.2ml)was less than that of the control group(136.9±17.3ml),and the difference was statistically significant(P=0.000).The number of times of fluoroscopy in the experimental group was(9.2 0.8)more than that in the control group(4.1 0.6),and the difference was statistically significant(P=0.000).After operation,the excellent and good rate of Burwell-Charnley radiology evaluation in the experimental group was 96.6%,and that in the control group was 87.1%,with no significant difference(P=0.3547).At the last follow-up,the excellent and good rate of AOFAS score of ankle joint function in the experimental group was 96.6%,and that in the control group was 90.3%,with no significant difference(P=0.6128).Conclusions: Compared with conventional open reduction and internal fixation surgery,closed reduced minimally invasive surgery can achieve good image reduction and better ankle function.However,the former is short in operation time,and the hemorrhage quantity under operation is small.Part Four Analysis of related factors affecting ankle function after operation of tibial Pilon fractureObjective: To explore the related factors affecting the ankle function after Pilon fracture of tibia.Methods: A retrospective study was designed to analyze the general data and postoperative ankle function of 36 patients with tibial Pilon fracture who were hospitalized in our hospital from March 2019 to May 2020 and received internal fixation.30 males and 6 females;14 cases on the left side and 22 cases on the right side;The age ranged from 22 to 70,with an average of 44.7.According to American Orthopedic Foot and Ankle Society(AOFAS)ankle and hindfoot function score,patients were divided into excellent group and nonexcellent group.Sex,age,injury side,injury mechanism,fracture classification,postoperative fracture reduction were compared,and the correlation analysis of ankle function was carried out on statistical significance factor.Examination of the risk factor of ankle joint function after tibial pilon fracture surgery.Results: Excellent clinical effect group: 13 males and 3 females.7 cases on the left and 9 cases on the right.The age ranged from 22 to 62,with an average of 44.3±9.9 years.Non-excellent clinical curative effect group: 17 males and 3 females.There were 7 cases on the left and 13 cases on the right.The age ranged from 26 to 70,with an average of 45.0±12.7.There was no significant difference in age,sex,injury side and injury mechanism between the two groups(P<0.05).Through correlation analysis,it is found that fracture classification and postoperative fracture reduction quality are risk factors affecting ankle function.Fracture classification and the quality of postoperative fracture reduction were found to be a risk factor affecting ankle function.The fracture classification had a negative correlation with postoperative ankle function,and the postoperative resting showed positive correlation with postoperative ankle function.Conclusions: Fracture classification and postoperative reduction quality are the influencing factors of excellent ankle function of Pilon fracture of tibia.Patients with high fracture classification may get poor ankle function.Improving the reduction quality of fracture can improve the postoperative ankle function of patients. |
PDF Full Text Request