| Objective:to observe the effect of medial approach and the incidence of complications in patients after Pilon fracture.Methods:46 patients with Pilon fracture received in our hospital from September 2016 to October 2018 were selected for clinical investigation.All the above patients were classified into observation group and control group,23 cases.The control group was treated with the posterior lateral approach,and the observation group was treated with the posterior medial approach,all of which were followed up for one year.The length of incision after treatment,the amount of bleeding during operation,the time of fracture healing,the wound healing in 15 days after operation,the recovery rate of ankle joint function after one year after operation,and the complications were compared between the two groups.Results:In the control group and observation group,the incision lengths of the patients with single bone block were(9.87±1.48)cm and(9.90±1.47)cm,and the intraoperative blood loss was(165.78±3.54)ml and(164.22±2.661)ml,respectively,and the fracture healing time They were(9.09±0.83)weeks and(9.00±0.85)weeks respectively,the two groups of patients were not statistically significant(P>0.05);the incision lengths of the patients with double bone fractures in the control group and observation group were(14.97±1.32,respectively))Cm and(11.06±1.44)cm,the intraoperative blood loss was(207.18±17.83)ml and(180.75±4.27)ml,and the fracture healing time was(9.58±0.99)weeks and(9.36±0.92)weeks,respectively.The comparison of patients in the two groups was not statistically significant(P>0.05);the incision length and the amount of intraoperative bleeding in the two groups were statistically significant(P<0.05);the fracture healing time was not statistically significant(P>0.05).0.05).The lengths of type II incision in control group and observation group were(10.13± 1.62)cm and(9.91± 1.41)cm,intraoperative blood loss was(167.95±7.13)ml and(165.03±5.22)ml,fracture healing time They were(9.23± 1.30)weeks and(9.15± 1.07)weeks respectively.The comparison between the two groups was not statistically significant(P>0.05);the length of type III incision in the control group and observation group was(15.27± 1.23)cm and(11.28± 1.31)cm,intraoperative blood loss was(212.65± 13.14)ml and(180.93±4.46)ml,fracture healing time was(9.80±0.63)weeks and(9.60±0.84)weeks,two groups There is no statistical significance in comparison(P>0.05).The 15-day postoperative healing of patients with single bone block,double bone block,Rüedi-Allgwer type II and III were compared,and the results showed that there was no statistical difference between the single bone block patients’ 15-day healing(P>0.05);double bone There was no statistical difference in grade B healing in patients with massive fractures(P>0.05),but there was a statistical difference in grade A and grade C healing(P<0.05).Rüedi-Allgwer type III patients had no statistical significance in grade B healing(P>0.05),while grade A and grade C healing had statistical significance(P<0.05).The wound healing of the two groups of patients after 15 days of surgery was generally significant(P<0.05).There were 2 cases(8.70%)of grade C healing in the control group,and only 1 case(4.35%)in the observation group.All patients had incision suppuration due to incision infection.After 2 months of drainage,dressing change,and corresponding anti-infection treatment,3 patients in both groups recovered and reached Grade A healing.Compared with the overall healing situation,the observation group was significantly better than the control group,with statistical significance(P<0.05).Among the patients with single bone fractures,6 cases of the control group had a good recovery of posterior ankle joint function after 1 year,accounting for 54.55%.There were 4 good cases,accounting for 27.27%,1 medium case,8.33%,and 0 poor case.In the observation group one year after operation,the recovery of posterior ankle function was excellent in 7(58.33%)cases,good in 4(33.33%)cases,moderate in 1(8.33%)cases,and poor in 0 cases.There was statistical significance(P>0.05).Among the patients with double bone fractures,the control group had a good recovery of posterior ankle function in one year after operation,accounting for 15.38%,good in 8 cases,accounting for 61.54%,and medium in 1 case,accounting for 8.33%,1 case was poor,accounting for 8.33%,7 years(63.64%)cases of posterior ankle function recovery were excellent,3 cases(27.27%)cases were good,1 case(0.91%)cases were poor in observation group.The comparison between the two groups of patients was statistically significant(P<0.05);.the control group of Rüedi-Allgwer type Ⅱ patients had a 38.46%excellent recovery of posterior ankle function after one year of operation,and 6 cases were good,accounting for 46.15%.Among them,2 cases accounted for 15.38%and 0 cases were poor.In the observation group,postoperative ankle function recovery was excellent in 8 cases(61.53%),good in 3 cases(23.07%),medium in 2 cases(15.38%),poor 0 cases.Comparing the two groups of patients,it was not statistically significant(P>0.05);one year after surgery,among the Rüedi-Allgwer type Ⅲ patients,the control group had excellent recovery of the posterior ankle function in 3(30.00%)cases,good 5(50.00%),medium 1(10.00%),poor 1(10.00%),observation group,excellent 6(60.00%),good 3(30.00%),medium 1(10.00%),poor 0 The recovery of the two groups of patients was not statistically different(P>0.05);early postoperative complications of the patients mainly included fibular tendon stimulation,numbness of the dorsal foot muscles,hypoalgesia,poor wound healing,and infection,among which the fibula in the control group One case of tendon muscle stimulation accounted for 4.34%,2 cases of numbness and pain in the dorsal foot muscles accounted for 8.69%,1 case of poor wound healing accounted for 4.35%,and 0 cases of infection.The rate of early complications was 17.39%.In the observation group,there were 0 cases of fibular tendon stimulation,1 case of numbness and hypoalgesia of the dorsal foot muscle,accounting for 4.35%,1 case of poor wound healing,accounting for 4.35%,and 0 cases of infection.The rate of early complications was 8.69%.There was a statistically significant difference between the two groups of patients(P<0.01);in the late postoperative complications of the two groups,2(8.70%)cases of malformation in the control group,1(4.35%)bone nonunion,and 1(stiff joint)4.35%)cases,1(4.35%)traumatic arthritis,1(4.35%)case of deformity healing in the observation group,1 case of nonunion(4.35%),0 cases of joint stiffness,0 cases of traumatic arthritis,two There was a statistically significant difference in the incidence of late complications among patients in the two groups(P<0.01)Conclusion:During the surgical treatment of patients with Pilon fractures,for patients with a single bone fracture,the treatment effect of the posterolateral approach is similar to that of the posteromedial approach.Therefore,it is economically cheaper to choose these patients Methods.However,for patients with double bone fractures,the posterior medial approach is significantly more effective,which can significantly reduce the length of the incision and the amount of bleeding during the operation.The use of postero-medial approach will reduce the incidence of complications in patients,so during the surgery,the corresponding surgical approach can be adopted according to the actual situation of the patient.In addition,Rüedi-Allgwer classification has no effect on patient treatment and prognosis. |
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