内外固定分期序贯与切开复位内固定治疗pilon骨折的疗效比较

目的:比较内外固定分期序贯与切开内固定治疗高能量损伤pilon骨折的疗效。方法:回顾性研究2015年1月至2017年7月本课题组收治的61例高能量pilon骨折患者资料。根据方法不同分为内外固定分期序贯治疗组（序贯组）和单纯切开复位内固定治疗组（内固定组）。序贯组26例，男19例，女7例；年龄18~65岁；骨折OTA分...

Sequential therapy of external-internal fixation versus internal fixation alone for pilon fracture

Objective To compare the therapeutic effects between sequential therapy of external-internal fixation and internal fixation alone in the treatment of high-energy pilon fracture.Methods A total of 61 patients with high-energy pilon fracture were enrolled by our team for this retrospective analysis who had been treated from January 2015 to July 2017.They received sequential therapy of external-internal fixation(the sequential group)or internal fixation alone(the internal group).In the sequential group of 26 cases,there were 19 males and 7 females(aged from 18 to 65 years),4 cases of type C1,8 cases of type C2 and 14 cases of type C3 by the OTA classification,and 7 cases of closed injury and 19 cases of open injury.In the internal group of 35 cases,there were 25 males and 10 females(aged from 19 to 64 years),6 cases of type C1,13 cases of type C2 and 16 cases of type C3 by the OTA classification,and 21 cases of closed injury and 14 cases of open injury.The 2 groups were compared in terms of postoperative infection,fracture reduction,fracture union time,nonunion,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,short form 36 health survey questionnaire(SF-36)and reduced range of motion between healthy and affected ankles.Results There was no significant difference between the 2 groups in gender,age,fracture type,injury cause or follow-up time(P>0.05),but a significant difference in soft tissue injury favoring the sequential group(P=0.010).There were no significant differences between the 2 groups in postoperative infection rate[15.4%(4/26)versus 17.1%(6/35)],fracture reduction,fracture union time[(7.4±3.4)months versus(6.5±3.2)months],nonunion rate[7.7%(2/26)versus 8.6%(3/35)],AOFAS ankle-hindfoot score(71.7±29.4 versus 74.4±19.5),or SF-36(83.1±9.9 versus 83.8±7.9)(P>0.05).The reduced range of motion between healthy and affected ankles at 6 months postoperation in the sequential group(34.6°±7.2°)was significantly greater than that in the internal group(23.7°±5.1°)(P<0.05),but there was no significant difference between the 2 groups in the reduced range of motion between healthy and affected ankles at 2 years postoperation(26.0°±11.1°versus 21.8±11.3°)(P>0.05).Conclusion Although both sequential therapy of external-internal fixation and internal fixation alone can lead to fine clinical efficacy in the treatment of high-energy pilon fracture,the former may be more suitable for the patients with severe soft tissue injury.