胡文帅 范文俊 赵进喜

[摘要]目的探討复杂 Pilon 骨折患者后外侧联合前内侧入路手术治疗后骨代谢指标、踝关节功能及安全性。方法对2015年9月至2019年9月麻城市人民医院骨外科接收的100例复杂 Pilon 骨折合并腓骨骨折患者的数据资料进行回顾性分析，根据不同手术方式分为对照组（前外侧入路手术）、观察组（后外侧联合前内侧入路手术），每组各50例，比较两组手术相关性指标、术后复位效果、踝关节功能及骨代谢指标[血清骨钙素（BGP）、I 型前胶原 N-端前肽（PINP）及骨型碱性磷酸酶（BALP）]水平。结果观察组手术时间短、骨折愈合时间、完全负重时间均短于对照组，差异有统计学意义（P <0.05）。术后12个月，观察组患者复位效果、骨踝关节功能恢复效果明显优于对照组，差异有统计学意义（Z=2.074、2.760，P <0.05）。术后1个月，观察组患者血清 BGP、BALP、PINP 水平均明显高于对照组，差异有统计学意义（ P <0.05）。结论后外侧联合前内侧入路应用于复杂 Pilon 骨折的临床效果显著，既可以有效改善患者骨折复位效果与踝关节功能，还可以加速骨折愈合，建议推广应用。

[关键词]复杂 Pilon 骨折;手术入路;骨代谢;踝关节功能

[中图分类号] R687.3  [文献标识码] A   [文章编号]2095-0616（2021）24-0221-04

Analysis of bone metabolism index， ankle function and safety of patients with surgical treatment of complex Pilon fracture through posterolateral combined anterolateral approach

HU  Wenshuai    FAN  Wenjun    ZHAO  Jinxi

Department ofJoint Surgery， Macheng People's Hospital， Hubei， Macheng 438300， China

[Abstract] Objective To investigate the bone metabolism index， ankle function and safety of patients with surgical treatment of complex Pilon fracture through posterolateral combined anterolateral approach. Methods The data of 100 patients with complex Pilon fracture complicated with fibular fracture presented to the Department of Orthopaedics， Macheng People's Hospital from September 2015 to September 2019 were analyzed retrospectively. They were divided into the control group （anterolateral approach） and the observation group （lateral combined anterolateral approach）， with 50 cases in each group. The operation-related indexes， postoperative reduction effect， ankle function and bone metabolism index （serum bone gla protein [BGP]， procollagen I N-terminal propeptide [PINP] and bone alkaline phosphatase [BALP]） were compared between the two groups. Results The operation time， fracture healing time and complete weight bearing time of the observation group were shorter than those of the control group， with statistically significant differences （P <0.05）. Twelve months after operation， the reduction effect and the recovery effect of ankle joint function in the observation group were obviously better than those in the control group， with statistically significant differences （Z=2.074， 2.760， P <0.05）. One month after operation， serum BGP， BALP and PINP levels in the observation group were significantly higher than those in the control group， with statistically significant differences （P <0.05）. Conclusion Posterolateral combined anteromedial approach has a remarkable clinical effect in treating complex Pilon fracture， which can not only effectively promote fracture reduction and ankle function， but also accelerate fracture healing， which is worthy of popularizing in clinic.

[Key words] Complex Pilon fracture; Operative approach; Bone metabolism; Ankle joint function

Pilon 骨折即累及胫骨远端负重关节面的骨折，多伴有腓骨骨折且涉及内踝、外踝、后踝，虽在临床中较为少见，但治疗却甚为困难[1-2]。临床将胫骨负重关节面破坏程度严重、围软骨组织损伤严重且预后欠佳的骨折称为复杂 Pilon 骨折，这一类骨折存在手术难度大、并发症多、术后疗效欠佳的问题[3]。临床实践表明，不同手术入路对复杂 Pilon 骨折患者预后影响不同，前侧、后侧入路手术所获得的临床疗效不尽一致[4]。为探寻有效的复杂 Pilon 骨折手术入路术式，改善复杂 Pilon 骨折患者预后，本研究拟探讨采用后外侧联合前内侧入路手术治疗复杂 Pilon 骨折的临床疗效与安全性及对患者骨代谢指标、踝关节功能的影响。现报道如下。

1资料与方法