| Objective:To investigate the different curative effect of the fractures and soft tissue prognosis when the fibula is fixed by locking plate fixation or intramedullary nail fixation in the Pilon fractures and ankle fractures.To provide reference for clinical treatment,in order to obtain better therapeutic effect.Methods:Retrospective study 93 patients with Pilon fracture or ankle fracture admitted to the orthopaedic ward of our hospital from October 2016 to October 2018.All patients were divided into group A and group B.in group A,46 patients were treated with locking plate internal fixation for fibula and open reduction plate internal fixation or percutaneous minimally invasive locking plate internal fixation for distal tibial fracture(Pilon fracture),open reduction hollow lag screw internal fixation(ankle fracture).In group B,the fibula was fixed with intramedullary nail,and the distal tibial fracture was treated with open reduction plate internal fixation or percutaneous minimally invasive locking plate internal fixation(Pilon fracture)or open reduction hollow lag screw internal fixation(ankle fracture).Follow-up of 12 to 18 months,make the statistics of two groups of patients with operation time,intraoperative blood loss,intraoperative fluoroscopy times,length of incision,postoperative complications,(postoperative infection,delayed healing wound,postoperative incision skin edge aseptic necrosis,fracture delayed union and nonunion),fracture healing time and at the time of the last follow-up clinical limb function of ankle joint.Olerud-molander ankle function score was used at the last follow-up.Results:The average operative time of the patients in group A and group B was 120.23± 20.56 minutes,116.54±25.78 minutes,the average intraoperative blood loss was 99.78 ±15.09 ml,95.67± 17.84 ml,the average number of fluoroscopy was 15.98± 6.78 times,17.03 ±5.13 times,the average incision length was 15.23 ±3.21 cm,14.89± 3.30 cm,the average fracture healing time was 20.67 ± 2.44 weeks,18.32 2.21 weeks.At the last follow-up,the scores of ankle function in group A and group B were 86.56 ±8.12 and 91.23 ±7.28.There was no significant difference between the two groups in terms of operation time,intraoperative blood loss,number of fluoroscopy and incision length,P > 0.05.In terms of fracture healing time,the clinical fracture healing time of group B patients was less than that of group A patients,P < 0.05,and the difference was statistically significant.At the last follow-up,the functional score of the ankle joint was higher in group B than in group A,and the difference was statistically significant(P < 0.05).In terms of the incidence of complications,postoperative complications occurred in 10 patients in group A,and the incidence of complications was 21.74%.Postoperative complications occurred in 3 patients in group B,and the incidence of complications was 6.38%.In terms of the incidence of complications in the two groups,the incidence of complications in group B was lower than that in group A,with P value < 0.05,and the difference was statistically significant.Conclusion:In the treatment of Pilon fracture and ankle fracture,different internal fixation methods for fibula fracture will affect the distal tibiofibula fracture and the recovery of soft tissue.Compared with locking plate fixation,intramedullary nail fixation of the fibula is more consistent with the concept of minimally invasive,which can provide a better biomechanical environment for fracture and less secondary damage to soft tissue,which is conducive to the recovery of distal tibiofibula fracture?soft tissue and ankle joint function,and reducing the incidence of complications and recovering. |
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