Abstract
Objective — to develop and implement improved approaches to the diagnosis and tactics of surgical treatment in patients with fractures of the distal tibia metaepiphysis.Material and methods. The study included 126 patients with fractures of distal tibia metaepiphysis of «B» and «C» types who underwent internal fixation with plates in 2005–2012. The authors analyzed surgical treatment outcomes within the period from 2.5 to 9 years (average of 5.7–2.3 years) of postoperative follow up. Average age of patients was 23.4±2.1 years. Patients were divided into the main group (64 patients) and the comparison group (62 patients). In the comparison group, traditional approaches to diagnosis and surgical treatment were used, including standard clinical examination and X-rays of the affected ankle in two views and the median access to the distal tibia metaepiphysis. In the main group, a specially elaborated algorithm for selection of optimal surgical tactics was utilized basing on the improved diagnostics program. Clinical and functional data were assessed by Foot and Ankle Outcome Score (FAOS) and SF-36 Health Survey. Roentgenological assessment was done by X-rays and CT scans. Statistical significance of the differences was evaluated by Wald-Wolfowitz and Fisher tests.Results. Improved approaches to the tactics of surgical treatment in patients with pylon fractures of «B» and «C» types allowed to reduce the incidence of unsatisfactory anatomical and functional outcomes from 43.5% to 28.1%. The number of satisfactory and good outcomes increased by 4.7% and 10.7% respectively after application of improved therapeutic and diagnostic approaches.Conclusion. Proposed improved approaches to verification of severe intraarticular fractures of the distal tibia metabiphysis allowed to increase the informative value of the diagnostic procedures and to avoid discrepancies between preand intraoperative assessment of fracture type by classifications of M. Mueller-AS (1989) and X. Tang, P. Tang (2012) as well as to avoid diagnostic errors in detecting the facet impression of the distal tibia metaepiphysis.
Highlights
Patients were divided into the main group
specially elaborated algorithm for selection of optimal surgical tactics was utilized basing on the improved diagnostics program
functional data were assessed by Foot
Summary
6, Санкт-Петербург, 194044, Россия 2 ФГБУ «Санкт-Петербургский многопрофильный центр» Минздрава России набережная р. 154, Санкт-Петербург, 190103, Россия 3 ФГУ «1472 военно-морской клинический госпиталь» Минобороны РФ ул. Резюме Цель исследования – разработать и внедрить усовершенствованные подходы к диагностике и тактике хирургического лечения пострадавших с переломами дистального метаэпифиза большеберцовой кости. В исследование включены 126 пострадавших с переломами дистального метаэпифиза большеберцовой кости типов В и С, которым выполнили накостный остеосинтез пластинами в 2005–2012 гг. Результаты хирургического лечения изучены в срок от 2,5 до 9 лет (в среднем 5,7±2,3 года) после операций у 126 больных. Усовершенствованные подходы к тактике хирургического лечения пострадавших с переломами пилона типов В и С позволили сократить частоту неудовлетворительных анатомо-функциональных исходов с 43,5% до 28,1%. Ключевые слова: переломы дистального метаэпифиза большеберцовой кости, хирургическое лечение переломов голеностопного сустава. Сравнительный анализ результатов лечения пострадавших с переломами дистального метаэпифиза большеберцовой кости типов В и С. Рукопись поступила/Received: 05.06.2017. принята в печать/Accepted for publication: 01.09.2017
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