| Objective:(1)To investigate the clinical efficacy of anterolateral approach(AL)and anteromedial approach(AM)in the treatment of tibial Pilon fracture.(2)Clear surgical indications and the choice of surgical timing.Methods: The case data of 42 cases(collection time: September 2014 to September 2019)of surgically treated Pilon fracture in our hospital were retrospectively analyzed,including general basic data,fracture description,operation time,length of stay,blood loss,number of operations,surgical outcomes,and incidence of complications.Radiological evaluation and functional evaluation of tibial Pilon fracture were performed by the evaluation criteria of Burwell-Charnley(1965)and Tornetta et al.(1993).(Burwell-Charnley(1965): radiological evaluation criteria for reduction of Pilon fracture;Tornetta et al.(1993): evaluation criteria for clinical outcomes of Pilon fractures.Results: Both groups were followed up to weight-bearing walking and good ankle function.The follow-up time of all patients in both groups was 6-24 months,with an average of 12 months.Both of these two surgical methods can treat tibial Pilon fracture,and both have obvious effects.(1)Among the 19 patients in group A,the operation time of anterior medial approach incision was(108.16 ±9.98)min,the hospitalization time was(14.26±3.87)days,the blood loss was(165.79±6.29)ml,the number of operations was(2.00±0.30),4 cases of osteomyelitis,7 cases of incision infection,1 case of bone nonunion and 1 case of malunion.According to the radiological evaluation criteria for reduction of Pilon fracture(burwell-charnley,1965),there were 15 cases of anatomical bone position,4 cases of reduction,and 0 cases of reduction difference.According to Tornetta et al.(1993)evaluation criteria for clinical treatment results of Pilon fracture: 10 cases were excellent,6 cases were good,2 cases were acceptable,and 1 case was poor.(2)Compared with group B,there was no statistical significance in operation time,hospital stay,blood loss,operation times,bone nonunion,malunion and radiological evaluation(P > 0.05).However,the differences in osteomyelitis,incision infection and functional evaluation were statistically significant(P<0.05).Conclusion: Both anterolateral and anteromedial approaches have their own clinical effects in the treatment of tibial Pilon fractures.Both approaches can be used depending on the injury situation.However,surgeons must be aware of the high incidence of complications associated with all Pilon injury patterns.In an interesting application,the anterolateral approach has been found to be suitable for lateral comminuted fractures with Chaput bone fragments;The anteromedial approach is used to treat large Chaput fragments that are very close to the medial side,and once incarceration is treated,Chaput fragments can help restore the medial malleolus fragments.The results of this study demonstrated that there were more anteromedial incision infections and osteomyelitis,but the reduction quality was better than that of anterolateral incision. |
