| Objective: The clinical data of 48 patients with type II and type III pilon fractures treated by our department were studied,and the two surgical options of double-reverse traction homeopathic reduction combined with MIPPO technique and conventional open reduction and internal fixation were compared in groups for type II and type III pilon fractures.The clinical efficacy of pilon fractures is to find a better solution for the clinical surgical treatment of type II and type III pilon fractures.Method: A retrospective case-control study was used to analyze the clinical data of 48 patients with type II and type III pilon fractures admitted to the Department of Orthopedics,Qingdao University Affiliated Hospital from March 2017 to April 2020.Among them,there were 28 males and 20 females;according to the Ruedi-Allgower classification of pilon fractures,19 cases were type II and 29 cases were type III;the injury side: 27 cases on the left side and 12 cases on the right side;the cause of injury: 22 cases were injured in traffic accidents,15 cases of fall injury,and 11 other cases.According to the results of preoperative doctor-patient communication,28 cases were treated with dual-reverse traction homeopathic reduction combined with MIPPO technique(double-reverse traction group),and 20 cases were treated with conventional open reduction and internal fixation(conventional incision group).The intraoperative blood loss,fluoroscopy times,fracture reduction time,operation time,incision length,hospital stay,incision healing grade,fracture healing time,walking time,and full weightbearing activity time were compared between the two groups,and the visual analogue scale(VAS)was used to evaluate The postoperative pain status of the two groups of patients was evaluated by the American Foot and Ankle Surgery Association(AOFAS)ankle-hindfoot score to evaluate the ankle joint function of the two groups before operation and at the last follow-up,and the ROM score was used to evaluate the ankle joint activity of the two groups of patients before and at the last follow-up.The good and good rate of fracture reduction was evaluated by Burwell-Charnley imaging,and the complications were observed.Results: All patients were followed up for 13-30 months,with an average of(21.35±3.82)months.In double reverse traction group,intraoperative blood loss(165.0±47.6)ml,times of fluoroscopy(12.68±1.42)times,fracture reduction time(40.0±4.5)min,operation time(141.75±4.19)min,incision length(19.07±2.49)cm,were less than the routine incision group intraoperative blood loss(195.5±48.8)ml,fluoroscopy times(14.20±2.51)times,fracture reduction time(50.3±4.4)min,operation time(145.05±6.14)min,(p<0.05)),incision length(30.80±4.10)cm,the difference was statistically significant(p>0.05).The incision healing grade of the double-reverse traction group(28 cases A,0 cases B,and 0cases C),and the conventional incision group(18 cases A,1 case B,and 1 case C),there was no statistical difference in the grade of incision healing between the two groups.academic significance(p>0.05).The time of walking on the ground in the double-reverse traction group was(63.04±18.17)d,and in the conventional incision group(59.40±8.80)d,there was no significant difference between the two groups(p<0.05).The full weightbearing activity time of the patients in the double-reverse traction group was(12.30±1.52)weeks,and the routine incision group was(11.87±1.91)weeks,and there was no significant difference between the two groups(p<0.05).The length of hospital stay in the double-reverse traction group was(11.54±2.15)d,while that in the conventional incision group was(12.75±4.12)d.There was no significant difference in the hospitalization time between the two groups(P>0.05).3 days after operation,2 weeks after operation,and 1month after operation were(5.18±1.54),(3.57±1.26),(2.1±1.3),respectively,which were better than those of the conventional incision group(6.50±1.67),(4.80±1.37)1.47),(3.2±1.8),and the difference was statistically significant(p<0.05).At the last follow-up,the VAS score of the patients in the double-reverse traction group was(1.11±0.83),and that in the conventional incision group was(1.45±0.89),the difference was not statistically significant(P>0.05).After more than 1 year of follow-up,the AOFAS and ROM scores at the last follow-up were significantly increased compared with those before surgery(P<0.05),but at the same time,there was no significant difference in the AOFAS and ROM scores between the two groups(P >0.05).In terms of imaging,according to the standard of Burwell-Charnley,the fracture reduction quality in the double-reverse traction group(excellent in 16 cases,good in 10 cases,and poor in 2cases),and in the conventional incision group(excellent in 15 cases,good in 4 cases,and poor in 1 case),in both cases.There was no significant difference in the quality of intraoperative fracture reduction between the two groups(P>0.05).The follow-up results showed that there was no significant difference in fracture healing time between the two groups in postoperative imaging(P>0.05).Conclusion: For type II and type III pilon fractures,double-reverse traction homeopathic reduction combined with MIPPO technique and conventional open reduction and internal fixation were used for the treatment of two groups of patients.The long-term follow-up results were similar,and satisfactory curative effects were obtained.However,the use of double-reverse traction homeopathic reduction combined with MIPPO technology for the treatment of type II and type III Pilon has the advantages of short operation and fracture reduction time,less intraoperative fluoroscopy times and less blood loss,small incision,and less pain in the short term after surgery.It can reduce the intraoperative injury,reduce the postoperative pain of patients,save the labor intensity of medical staff,and is worthy of clinical promotion. |
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