手术时机选择对胫骨Pilon骨折手术疗效的影响

目的：评估伤后手术时机选择对胫骨Pilon骨折疗效的影响。方法：选取自2003年6月至2008年5月有随访记录的65例胫骨Pilon骨折患者,男42例,女23例;年龄15～62岁,平均（37.53±6.32）岁。按受伤至手术时间分为两组,A组30例,伤后3～7d行切开复位植骨解剖钢板内固定术;B组35例,采用分步延期开放复位内固定,于伤后7～24d软组织肿胀消退后行切开复位植骨内固定术。术后观察两组创面及骨折愈合情况,参照Bourne对胫骨Pilon骨折的愈合评价进行踝关节功能评估。结果：65例患者均获得随访,时间7～24个月,平均16.23个月。A组3例并发感染,4例刀口裂开,1例内固定物外露,1例骨髓炎;B组2例表浅感染,其余全部Ⅰ期愈合,B组在伤口愈合方面明显优于A组。A组患者的骨折愈合时间为（18.3±3.2）周,B组为（15.7±2.5）周,A组骨折愈合时间明显长于B组（P〈0.05）。参照Bourne对胫骨Pilon骨折的愈合评价：A组优12例,良10例,差8例,优良率为73.3%;B组优21例,良8例,差6例,优良率为82.9%,B组优于A组（P〈0.05）。结论：手术时机的选择是高能量胫骨Pilon骨折治疗的关键,选择合适的手术时机,采用分步延期开放复位内固定是治疗高能量胫骨Pilon骨折有效的方法。

Influence of operative time on effect of the Pilon fracture

Objective: To evaluate the influence of operative time on treating high-energy tibial Pilon fracture. Methods: From June 2003 to May 2008,Sixty-five patients with tibial Pilon fracture were followed up. There were 42 males and 23 females in the study. The age was from 15 to 62 years with an average of(37.53±6.32) years. The patients were divided into two groups (group A and B) according to operative time. In the group A,30 cases were treated with open reduction internal fixation (ORIF) at 3-7 days after injury. In the group B,35 cases were treated with step-by-step postphoned ORIF at 7-24 days after injury (the swell of soft tissue extincted). The clinical effects were evaluated between two groups according to Bourne standard. Results: All patients were followed up from 7 to 24 months with an average of 16.23 months. There was significant difference on the early complications between two groups. In group A,3 cases of infection,4 cases of edge splitting,1 case of plate explosing and 1 case of osteomyelitis. In group B,only 2 cases of surface infection. The time of fracture healing in group A and B was respectively(18.3±3.2) weeks and(15.7±2.5) weeks. There was significant difference between two groups(P<0.05). According to the Bourne Pilon fracture healing standard,in group A,12 cases got excellent result,10 good,8 poor,the rate of excellent and good was 73.3%;in group B,21 cases got excellent result,8 good,6 poor,the rate of excellent and good was 82.9%. There was significant difference between two groups(P<0.05). Conclusion: The choice of operative time is the key to treat high-energy tibial Pilon fracture. Step-by-step postphoned ORIF is an effective method for high-energy tibial Pilon fracture.