影响胫骨Pilon骨折疗效的相关因素分析

目的]探讨影响Pilon骨折疗效的相关因素.方法]胫骨Pilon骨折152例,根据骨折粉碎、移位的影像学改变,将骨折分为4型.按治疗方法分为开放复位内固定组和其他治疗方法组,其中内固定组92例、其他治疗方法组60例,平均随访9.6年(1～19年).对影响其疗效的相关因素进行临床分析.结果]内固定组和其他方法治疗组复位质量优良率分别为83.70％、55.00％,治疗效果优良率平均为77.63％,其中内固定组优良率88.04％,其他方法组优良率61.67％.各型骨折内固定组的治疗效果优良率均高于其他方法组.术后并发症有浅表感染9例,创口裂开皮肤坏死延期愈合13例,外固定针道感染3例,骨延迟愈合2例,创伤性关节炎23例,深部感染骨髓炎1例.结论]影响Pilon骨折临床疗效的主要因素是骨折类型、治疗方法、复位质量.Ⅰ型骨折两种治疗方法复位均满意；Ⅱ、Ⅲ型骨折切开复位内固定能获得优良疗效,Ⅳ型骨折两种治疗方法均难于达到解剖复位,部分Ⅳ型骨折伴有软组织严重损伤者适宜选择外固定器治疗.

Analysis of related factors influencing the treatment efficacy in tibial pilon fracture

Objective]To discuss the related influencing factors of Pilon fracture.Method]Altogether 152 cases of Pilon fractures were involved in the study.Bone fracture falls into 4 classifications according to the bone shifts and crush of image changes.On basis of treatment methods,the patients were divided into two groups:group one,including 92 cases,were treated with open reduction and internal fixation,group two(60 cases) underwent different treatment.The mean followed-up period were 9.6 years(range,1-19 years).Meanwhile,the related factors influencing the treatment efficacy were studied.Result]The satisfactory rate of reestablishment in group one and group two were 83.70% and 55.00% respectively.The mean satisfactory rate of therapeutic effect were 77.63%,with group one reaching 88.04% and group two 61.67%.For different types of fracture treated with internal fixation,the satisfactory rate of therapeutic effect was higher.The postoperative complications included superficial infection(9 cases),wound dehiscence leading to delayed skin healing(13 cases),the external fixation needle road infection(3 cases),delayed bone healing(2 cases),traumatic arthritis(23 cases),and osteomyelitis(1 cases).Conclusion]The main influencing factors on clinical efficacy of Pilon fractures are fracture types,methods of treatment,and the quality of reestablishment.Both of the treatment methods in our practice for fractures Type I are satisfying,but for type II and type III open reduction and internal fixation can obtain better therapeutic effect.Neither of the two treatments achieve anatomical reestablishment for type IV fractures and external fixation treatment is more suitable for some type IV fractures associated with severe soft tissue injury.