| Objective:Comparing the posterior support plate and the posterior and posterior cannulated screws by comparing the operation time,the intraoperative blood loss,the postoperative BurwellCharnley radiological score,the postoperative weight-bearing time,the fracture healing time,and the postoperative ankle joint AOFAS score.The fixation effect of two fixation methods on Klammer II and type III posterior Pilon fractures provides a reference for Pilon fracture after clinical treatment.Methods:Collecting the 68 cases of surgical treatment of orthopedics in the Second Hospital of Shanxi Medical University from September 2015 to February 2018.The data were completely diagnosed as Klammer II and III type Pilon fracture patients,including 31 cases of Klammer type II,Klammer III.There were 37 cases,which were divided into group A(rear support plate fixation group)38 cases and group B(post posterior cannulated screw fixation group)according to different fixation methods.The operation time,intraoperative blood loss,postoperative weight-bearing time,and fracture healing time were compared between the two groups.The postoperative ankle joint X-ray films were evaluated by the Burwell-Charnley radiological standard for the reduction of the articular surface.The AOFAS score was used to evaluate the postoperative position.Ankle joint function at follow-up.Results:All the 68 patients in the two groups were followed up for 12 to 25 months,with an average time of 15.31±3.22 months.There were no complications such as delayed union or non-union,internal fixation loosening or fracture in both groups.1.Compared with the posterior and posterior cannulated screws,the operation time of the two groups of patients(min)[76.08±2.64 for the plate group,77.01±2.73 for the screw group,and the intraoperative blood loss(mL)[plate group 403.79±31.33,Screw group 397.20±33.32],there was no significant difference between the two groups(P>0.05).2.Two patients in group A developed posterior tibial tendon irritation,one in the 8 months after surgery,and one in the 10 months after surgery;one patient developed ankle pain after surgery and was diagnosed with trauma Arthritis;3 cases of postoperative incision superficial infection,cured after dressing change;2 cases of heel and lateral dorsal numbness,considered for intraoperative traction of the sural nerve.Three patients in group B had ankle pain during postoperative walking and were diagnosed with traumatic arthritis.One patient developed superficial infection after incision and healed after dressing change.One patient developed heel and lateral aspect of the foot.Feeling numb,considered for the intraoperative traction of the sural nerve.3.The load-bearing steel plate group(8.08±1.01)is shorter than the hollow screw fixation group(12.75±2.37).The fracture healing time support plate group(13.66±1.88)was shorter than the hollow screw fixation group(16.49±0.96),the difference was statistically significant(P<0.05).4.The post operation Burwell-Charnley radiology,the excellent and good rate of the hollow screw fixation group was 73.33%,and the excellent rate of the posterior support plate group was 94.47%.The plate group was better than the screw group,and the difference was statistically significant(P<0.05).5.3 months follow-up AOFAS score,the posterior support plate group(82.71±2.70)was superior to the hollow screw fixation group(74.13±2.49),the difference was statistically significant(P<0.05).12 months follow-up AOFAS score,the support plate group(88.39±2.66)and the hollow screw fixation group(87.97±2.27),the difference between the two groups was not statistically significant(P>0.05).Conclusion:1.For Klammer II,III,and posterior Pilon fractures,both fixation methods can achieve satisfactory medium-term fixation.2.The posterior support plate fixation was superior to the posterior and anterior screw fixation in the reduction rate,weight bearing time,fracture healing time and early postoperative recovery of ankle joint function.In clinical Klammer Ⅱ Pilon fractures after,Ⅲ,type,suggest to use the back support plate fixed priority. |
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