| Objective: To compare the clinical efficacy of Novel Locking Anatomical Plate with classical locking compression plate and to discuss the new pattern of internal fixation in the treatment of anterior column of Pilon fracture.Methods: To retrospectively analyze the 40 cases of patients from Feb.2010 to Feb.2015 who had been admitted into Orthopedic Trauma department, The First Affiliated Hospital of Dalian Medical University and diagnosed as closed Pilon fracture through X-ray and CT-scan(all distal tibial anterior surfaces interfered indicated by 3D-reconstruction), and conformed to surgical indications, all of which cases selected were classified in accordance with internal fixatiors into LAP group(15 cases) and LCP group(25 cases). All cases, whose ankle joints had been through X-ray, CT-scan and 3D reconstructions pre-operatively and acknowledged thoroughly in terms of fracture comminuity, and surgical approaches of which were determined on the basis of AO/OTA and Four-comlumn Classification, had undergone operations under general anaesthesia through anterior(anterolateral or anteromedial) approach. LAP group were applied with novel anterior distal tibial locking anatomical plate, LCP group with classical locking compression plate, which had been followed up since post-operaitve 6 weeks. To compare the relevant parameters including morphology and scewing fixation angle between two plates and record patients’ gender, age, injury mechanism, fracture interference, classification, operation time, surgical approaches, length of stays, fracture union and side effects etc. To evaluate the fracture reduction following Burwell-Charnley radiograhic standard of fracture reduction, and ankle joint recovery situation through ankle and posterior foot scoring system by AOFAS and clinical efficacy by Tornetta clinical evaluation standard in the treatment of Pilon fracture and finally compare the short-term and long-term complications between two groups. All data were statistically-analyzed through SPSS 15.0.Results:(1) There is no statistical difference between two groups in the aspects of gender, age,fracture-to-admission time, frracture-to-operation time, injury mechanism, fracture interference and AO/OTA classification.(2)There are statistically significant differences in the designing parameters of two types of plates between two groups of patients, however, as to the incidence of side effects of internal fixators, although the incidence of LCP slightly higher than the LAP group, but the result is not statistically significant(P>0.05).(3)LAP group: the operative time was(70.52±14.75) min, length of hospital stay(7.85 ± 1.38) days, both LCP group was significantly shortened(P<0.05); LAP group of patients with fracture union time was(14.03±3.62) weeks, the LCP group was significantly shortened(P<0.05).(4)LAP group: the ratio taken up by postoperative fracture anatomical reduction, fair reduction and unsatisfactory reduction are 66.67%, 33.33% and 66.67% respectively, the proportion of the trend of reduction result is better than that of LCP group, but no statistical significance is show(P>0.05).(5)All patients were followed up, follow-up of 3-12 months, an average of 5.6 months, LAP patients by AOFAS ankle-posterior foot scoring system are scored by(88.42±9.52), significantly higher than that of LCP group(P<0.05).(6)The clinical excellence rate in LAP group of Pilon fractures was 93.33%, significantly higher than that of LCP group(P<0.05).(7)The overall incidence of early complications and late complications in LAP group group were significantly lower than LCP group, which shows specific statistical significance difference(P<0.05), but there is no statistically significant difference between the two groups of patients with each single item observed in the incidence of postoperative complications(P>0.05).Conclusion: compared with traditional LCP, novel anterior distal tibia locking anatomical plate in the treatment of anterior column of Pilon fracture indicates more accurate and stable fixation effect, clinical treatment effect is satisfactory combined with less postoperative complications, which highlights its clinical value. |
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