有限内固定联合支架外固定术治疗复杂性Pilon骨折的疗效观察

目的：探讨有限内固定联合支架外固定术治疗复杂性Pilon骨折的临床疗效以及安全性。方法选取2010年2月至2014年2月我院收治的复杂性胫骨Pilon骨折患者80例，随机分为两组，联合固定组（40例）采用有限内固定联合支架外固定治疗，单纯内固定组（40例）采用切开复位内固定治疗。采用Burwell?Charnley骨折复位放射学评分评价复位情况，Tornetta等Pilon骨折临床治疗结果评价标准评价治疗结果，并比较两组并发症的发生情况。结果两组患者均随访时间3~6个月，平均随访时间为4.2个月。术后1周时，联合固定组22例达解剖复位，12例复位可，6例复位差；单纯内固定组19例达解剖复位，16例复位可，5例复位差，两组关节面复位情况比较，差异无统计学意义（χ2=0.882，P=0.643）。术后3个月，联合固定组临床治疗优良率为92.5%，显著优于单纯内固定组的80.0%（χ2=4.114，P=0.043）；两组并发症发生率分别为7.5%和5.0%，差异无统计学意义（χ2=0.213，P=0.644）。结论有限内固定联合支架外固定是治疗复杂性Pilon骨折的有效方法，可使损伤关节面达到解剖复位，有效恢复患者的踝关节功能。

Efficacy and safety of limited internal fixation combined with external fixation in the treatment of complex Pilon fractures

Objective To investigate the clinical efficacy and safety of limited internal fixation com?bined with external fixation in the treatment of complex Pilon fractures. Methods Eighty patients with com?plex tibial Pilon fractures in our hospital from February 2010 to February 2014 were randomly divided into two groups. The combined fixation group (40 cases) was treated with limited internal fixation combined with external fixation, and the simple internal fixation group (40 cases) was given open reduction and internal fixation. The Burwell?Charnley fracture reduction score was used to evaluate the reduction, the Pilon fractures clinical treat?ment outcome evaluation criteria of Tornetta were used to evaluate the treatment outcome, and the occurrence of complications in the two groups were compared. Results The two groups were followed up for 3?6 months (mean 4.2 months). Twenty?two cases in the combined fixation group reached anatomical reposition 1 week after operation, fair in 12 cases, and poor in 6 cases, while 19 cases reached anatomical reposition, 16 cases got fair, and 5 cases were poor in the simple internal fixation group. There was no statistically significant difference in the articular surface reduction between the two groups (χ2=0.662, P=0.643). At 3rd month after operation, the clinical excellent and good rate in the combined fixation group was 92.5%, significantly higher than in the sim?ple internal fixation group80.0%(χ2=4.114, P=0.043)]. The complication rate was 7.5%and 5.0%in the two groups with the difference being not statistically significant (χ2=0.213, P=0.644). Conclusion Limited inter?nal fixation combined with external fixation is an effective method for the treatment of complex Pilon fractures, the injured articular surface could achieve anatomical reduction, and the ankle joint function could get effective recovery.