Clinical Efficacy Of MIPPO Combined With Locking Compression Plate Internal Fixation In The Treatment Of Pilon Fracture

Objective: To investigate the clinical effect of minimally invasive percutaneous plate osteosynthesis(MIPPO)combined with locking compression plate(LCP)internal fixation in the treatment of tibial Pilon fractures.Methods: 57 cases of Pilon fracture treated in Department of orthopedics of our hospital from February 2006 to September 2014 were selected as the research objects,and the clinical data were retrospectively analyzed,according to treatment methods,patients were divided into the study group of 32 cases and the control group of 25 cases.Patients in the control group were treated with traditional open reduction and internal fixation,and patients in the study group were treated with limited open reduction of ankle joint with MIPO and LCP implantation.The general operation conditions,the evaluation of the treatment effect at the last follow-up,the fracture reduction,the ankle function of the affected side,the degree of soft tissue injury after treatment and the incidence of postoperative complications were compared between the two groups.Results:1.The operation time of the study group was significantly longer than that of the control group(P < 0.05).There was no significant difference in intraoperative blood loss between the study group and the control group(P > 0.05).The healing time of fracture of the study group was significantly shorter than that of control group(P < 0.05).There was no significant difference in hospitalization time between the two groups(P > 0.05).2.The average follow-up time of the control group was(27.9 ± 2.6)months,and the study group was(28.2 ± 2.9)months.There was no significant difference between the two groups(P > 0.05).The AOFAS ankle function scores and Mazur scores were significantly increased in the two groups after operation,and there were significant differences compared with those before operation(P < 0.05),and the AOFAS ankle function scores and Mazur scores in the study group at 6 months,12 months,24 months after the operationand the last follow-up were significantly higher than those in the control group(P < 0.05).3.The total effective rate of fracture reduction in the study group was 90.63%(29/32),which in the control group was 76.00%(19/25).There was no significant difference between the two groups(P > 0.05).At the last follow-up,the ankle function was evaluated by Mazur scoring system.The excellent and good rate of the observation group was90.63%(29/32),and significantly higher than 60%(15/25)of the control group,with statistical significance(P < 0.05).4.The ankle flexion and dorsiflexion activities of the two groups were all 0 degrees before operations,and were significantly improved after the operations,and the ankle mobility of the study group at 6 months,12 months,24 months after the operations and the last follow-up were significantly better than those of the control group(P < 0.05).5.The incidences of postoperative soft tissue injury,joint stiffness and skin infection in the study group were significantly lower than those in the control group(P < 0.05).Conclusion: The anterior arc incision combined with MIPPO and locking plate fixation for the treatment of Pilon fracture can not only ensure the anatomical reduction of the distal tibial articular surface and the functional reduction of the metaphysic,improve the joint reduction,increase the shutdown activity,and improve the postoperative ankle function,but also reduce the soft tissue dissection,reduce the soft tissue injury to the operation,protect the blood supply around the fracture to the greatest extent,reduce the postoperative infection,osteomyelitis,ankle stiffness and other early and late complications,promote the healing of fracture,it is conducive to the rehabilitation of patients as soon as possible.The surgical treatment of Pilon fracture effect is exact,it is worthy of clinical application.