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Objective:To investigate the therapeutic effects of internal fixation via the posterolateral combined posteromedial approach in the treatment of posterior pilon fracture (Klammer type Ⅲ).Methods:A retrospective study was performed to analyze the 69 posterior pilon fractures (Klammer type Ⅲ) which had been treated by internal fixation with hollow screws or a buttress plate at Department of Orthopaedic Trauma, Yantai Shan Hospital from January 2015 to January 2020. There were 36 males and 33 females with an age of (45.3±10.0) years and duration from injury to surgery of (6.0±1.5) d. They were assigned into 2 groups according to different surgical approaches. The observation group (41 cases) was treated through the posterolateral combined posteromedial approach while the control group (28 cases) through the posterolateral approach alone. The therapeutic effects were evaluated by comparing the 2 groups in terms of incision length, intraoperative bleeding, operation time, fracture union time, fracture reduction (evaluated by the Burrwell-Charnley radiological score), the ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS) and complications.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). All the 69 cases were followed up for (16.9±4.0) months, revealing primary healing of all the incisions and no vascular injury or wound infection. The incision length [(11.2±1.8) cm] and operation time [(76.0±6.6) min] in the observation group were significantly shorter than those in the control group [(12.4±1.9) cm and (79.7±6.8) min], the excellent and good rate of reduction in the observation group (97.6%, 40/41) was significantly higher than that in the control group (89.3%, 25/28), and the ankle-hindfoot scores of AOFAS at 1, 3 and 12 months after operation in the observation group [(78.4±5.6), (79.5±2.8) and (86.9±2.1)] were significantly higher than those in the control group [(75.2±5.5), (78.0±3.2) and (85.8±2.3)] (all P<0.05). There was no significant difference in the intraoperative bleeding between the 2 groups ( P>0.05). In the control group, 2 patients developed numbness in the dorsum of foot, which gradually disappeared after 3 months of treatment, but no other complications like persistent pain or flexor contracture within 1 year after operation. Conclusion:In the treatment of Klammer type Ⅲ posterior pilon fracture, the posterolateral combined posteromedial approach can result in satisfactory therapeutic effects, because the surgical approach can fully expose the fracture and facilitate better reduction.
RESUMO
BACKGROUND: The incidence of traumatic osteoarthritis is increasing in recent years. At present, total knee arthroplasty and unicondylar arthroplasty are commonly used in clinical treatment, and their therapeutic effects still need to be verified. OBJECTIVE: To compare effects between total knee arthroplasty and unicompartmental knee arthroplasty on the patients with traumatic knee osteoarthritiss. METHODS: A total of 102 patients with bilateral traumatic osteoarthritis were treated in the Affiliated Hospital of Qingdao University between January 2016 and June 2018. The patients were divided into total knee arthroplasty group and unicompartmental knee arthroplasty group (n=51 for each group). Operation indexes (operation time, intraoperative blood loss, decrease of hemoglobin 48 hours after operation, proportion of patients receiving blood transfusion during perioperative period, total length of stay and hospitalization cost) were compared between the two groups. Visual analogue scale score, American knee society knee score, and The Western Ontario and McMaster Universities osteoarthritis index were compared before surgery and 2 weeks, 3 and 6 months after surgery. The postoperative complications and subjective satisfaction after 6 months of follow-up were compared between the two groups. RESULTS AND CONCLUSION: (1) Operation time, intraoperative blood loss and decrease in hemoglobin at 48 hours after surgery were significantly lower in the unicompartmental knee arthroplasty group than those in the total knee arthroplasty group. The proportion of blood transfusion during perioperative period was significantly lower in the unicompartmental knee arthroplasty group than that in the total knee arthroplasty group. Total length of stay and hospitalization cost were significantly less in the unicompartmental knee arthroplasty group than those in the total knee arthroplasty group (P 0.05). Compared with those before surgery, visual analogue scale score and American knee society knee score were significantly lower; and The Western Ontario and McMaster Universities osteoarthritis index was significantly higher in both groups at 2 weeks, 3 and 6 months after surgery (P < 0.05). Visual analogue scale score, American knee society knee score, and The Western Ontario and McMaster Universities osteoarthritis index were significantly better in the unicompartmental knee arthroplasty group than those in the total knee arthroplasty group at various time points after surgery (P < 0.05). (3) During the 6-month follow-up, subjective satisfaction was significantly higher in the unicompartmental knee arthroplasty group than that in the total knee arthroplasty group (P < 0.05). (4) Complications: In the total knee arthroplasty group, there were 3 cases of postoperative infection and 2 cases of deep vein thrombosis, and the total incidence of postoperative complications was 10%. In the unicompartmental knee arthroplasty group, there was 1 case of postoperative infection, and the total incidence of postoperative complications was 2%. The incidence of postoperative complications in unicompartmental knee arthroplasty group was lower than that in total knee arthroplasty group, but the difference was not statistically significant (P < 0.05). (5) Unicompartmental knee arthroplasty in treatment of traumatic knee osteoarthritis has obvious advantages, can reduce length of stay and hospitalization cost, and patients have high satisfaction after operation. Unicompartmental knee arthroplasty is beneficial to the postoperative recovery of patients, and can be used as the first choice for clinical treatment of traumatic osteoarthritis.