ABSTRACT
Objective:To investigate the clinical effect of primary debridement combined with external fixation and secondary sequential internal fixation in the treatment of Rüedi-Allg?wer Ⅱ Pilon fracture.Methods:The clinical data of 36 patients with Rüedi-Allg?wer Ⅱ Pilon fracture from January 2017 to December 2019 in the People′s Hospital of Quzhou City, Zhejiang Province were retrospectively analyzed. Among them, 16 patients were treated with primary debridement with calcaneal traction and secondary internal fixation (internal fixation group), and 20 patients were treated with primary debridement combined with external fixation and secondary sequential internal fixation (combined fixation group). The operative time, intraoperative blood loss, postoperative drainage volume, time of full weight bearing, fracture healing time, American Society of Foot and Ankle Surgery (AOFAS) posterior ankle foot function score, visual analogue score (VAS), reduction quality (Burwell-Charnley score) and incidence of complication were compared between 2 groups.Results:The patients were followed up for 6 to 18 (10.7 ± 2.8) months. The time of full weight bearing and fracture healing time in combined fixation group were significantly shorter than those in internal fixation group: (7.2 ± 1.9) weeks vs. (9.4 ± 2.1) weeks and (3.4 ± 0.8) months vs. (4.1 ± 1.2) months, and there were statistical differences ( P<0.05 or <0.01); there were no statistical differences in operative time, intraoperative blood loss and postoperative drainage volume between 2 groups ( P>0.05). There was no statistical difference in AOFAS posterior ankle foot function score 1 month after surgery between 2 groups ( P>0.05); the AOFAS posterior ankle foot function score 3 and 6 month after surgery in combined fixation group was significantly higher than that in internal fixation group: (86.4 ± 1.7) scores vs. (75.7 ± 1.2) scores and (93.6 ± 2.2) scores vs. (82.1 ± 1.9) scores, and there was statistical difference ( P<0.05). There was no statistical difference in VAS between 2 groups ( P>0.05). There were no statistical differences in rate of reduction satisfaction and incidence of complication between 2 groups ( P>0.05). Conclusions:The primary debridement combined with external fixation and secondary sequential internal fixation for the treatment of Rüedi-Allg?wer Ⅱ Pilon fracture is conducive to the rapid recovery, which is worthy of extensive clinical promotion.
ABSTRACT
Objective To analyze the biomechanical changes of lateral atlantoaxial articulation by means of three‐dimensional fnite element models of craniocervical junction malformation(CJVM) .Methods CT scan images of 1 patients with CJVM were ob‐tained .The analytical model was constructed by advanced three‐dimension modeling and finite element softwares .A comparison of range of motion difference between the deformity model and normal model ,referring to the experience of clinical observation ,was used to verify the validity of the model .Applying respectively the same loads and boundary conditions on finite element model .The effectiveness was verified by contrastive analysis of the variation in lateral atlantoaxial joint stresses .Results The finite CJVM ele‐ment model with high geometric accuracyand reliable parameter had built .Compared to the results of cadaver test and finite element model based in normal cranio‐cervical junction ,the segment mobility coincides with the actual clinical performance in patients .The stress distribution the lateral junction between atlas and axis of can be reasonably explained the deformation of lateral atlanto‐axial joint structure and its important role in remaining stable between atlantoaxial vertebraeunder different physiological conditions .Con‐clusion The structure of lateral atlantoaxial joint changes in patients of CJVM ,the biomechanical stability for preoperative diagno‐sis and intraoperative treatment operation has a certain value .