高能量Pilon骨折分期治疗两种不同固定方法疗效的比较

 目的 比较高能量Pilon骨折分期治疗中锁定加压钢板内固定与有限内固定结合外固定的疗效。方法 回顾性分析2009-01至2013-10治疗的56例高能量Pilon骨折患者的临床资料。早期采用跟骨牵引或支具、石膏外固定后,二期按手术固定方法不同分为两组:A组27例行切开复位锁定加压钢板内固定,B组29例行微创有限内固定结合外固定。比较术后两组患者骨折愈合的时间、踝关节功能恢复、并发症情况。结果 A组骨折愈合时间(4.9±0.6)个月,B组(5.2±0.7)个月,两组比较差异无统计学意义。A组踝关节功能恢复优良率(81.5%)与B组(75.9%)比较,差异无统计学意义。A组共发生并发症5例(18.5%),B组7例(24.1%),两组比较差异无统计学意义;但感染发生率比较,A组(14.8%)高于B组(0)(P＜0.05)。结论 在高能量Pilon骨折分期治疗中,上述两种治疗方法均能取得满意效果且疗效相当,但对伴有重度软组织伤者,微创有限内固定结合外固定较切开复位锁定加压钢板内固定治疗,感染的风险更低。

Curative effect of high-energy Pilon fractures in staging treatment: comparison of two different fixed methods

Objective To compare high-energy Pilon fractures the efficacy of locking compression plate fixation and limited internal fixation combined with external fixation in staging treatment of high energy pilon fracture. Method The clinical data of fifty-six patients with high-energy Pilon fractures were retrospective analyzed. Calcaneal traction or plaster external fixation brace were used early. According to the fixation methods, they were divided into two groups: group A of 27 cases were treated with open reduction and internal fixation of locking compression plate; group B of 29 patients underwent minimally invasive limited internal fixation combined with external fixation. Fracture healing time, ankle joint function recovery, complications in the two groups were compared. Result In group A, fracture healing time was (4.9±0.6) months, in group B (5.2±0.7) months, the two groups had no statistically significant difference. Ankle joint function recovery rate (81.5%) in group A and group B (75.9%), the difference was not statistically significant. Complications occurred in 5 cases (18.5%) in group A, 7 cases (24.1%) in group B, the difference between the two groups was not statistically significant; but the infection rate in group A (14.8%) was higher than that in group B (0) (P<0.05). Conclusions In the high-energy Pilon fractures staging treatment, the above two treatment method can obtain satisfactory results and effect, but for those associated with severe soft tissue injuries, minimally invasive limited internal fixation combined with external fixation treatment has lower risk of infection.