损伤控制理论在C型Pilon骨折中的应用

Damage control theory in C-type pilon fractures

目的：评估运用损伤控制理论治疗C型Pilon骨折的近期疗效。方法：选取自2006年6月至2009年5月有随访记录的105例C型（AO分型）胫骨Pilon骨折患者,按受伤至手术时间分为两组,急诊手术组23例,伤后8 h内行切开复位植骨内固定术;损伤控制组82例,运用损伤控制理论对骨折及软组织进行初步处理,于伤后7~24 d软组织肿胀消退后行切开复位内固定术,必要时二期术后3~4个月行骨折端植骨。术后观察两组创面及骨折愈合情况,参照Ovadia对胫骨Pilon骨折的愈合评价进行踝关节功能评估。结果：105例患者均获得7~24个月,平均16.23个月随访。急诊手术组3例并发感染,3例刀口裂开,1例内固定物外露,1例骨髓炎;损伤控制组2例表浅感染,1例刀口裂开,3例二期植骨。损伤控制组在伤口愈合方面明显优于急诊手术组。所有患者均获骨折愈合,急诊手术组骨折愈合时间为（15.0±2.1）周,损伤控制组为（14.4±2.8）周,两组骨折愈合时间比较,差异无统计学意义（P〉0.05）。参照Ovadia对胫骨Pilon骨折的愈合评价：急诊手术组组优7例,良10例,可4例,差1例,优良率为73.9%;损伤控制组优41例,良32例,可8例,差1例,优良率为89.0%,损伤控制组优于急诊手术组（P〈0.05）。结论：运用损伤控制理论治疗高能量胫骨Pilon骨折,并发症少,创伤小,功能恢复好,近期疗效满意。

Objective：To assessment of the treatment of C-type Pilon fracture using damage control theory.Methods：Since June 2006 to May 2009 have recorded 105 cases were followed up for type C（AO classification） Tibial Pilon fracture patients,According to time from injury to surgery were divided into two groups： emergency surgery group,23 cases of emergency surgery after trauma experts 8h internal fixation open reduction.injury control group 82 cases,the use of damage control theory on the initial fracture and soft tissue treatment,at 7~24 d after injury,soft tissue swelling underwent open reduction and internal fixation,if necessary,After surgery in 3 to 4 months bone fracture line.Wound healing and fracture healing,Were observed after the operative.Reference Ovadia on the healing of tibial fractures Pilon evaluation of the ankle joint functional.Results：105 patients were followed up for 7 to 24 months,an average of 16.23 months.Emergency surgery complicated by infection in 3 patients,3 cases of incision dehiscence,one case of implant exposure,l cases of osteomyelitis;injury control group 2 cases of superficial infection,1 case of incision dehiscence,three cases of two bone graft,all patients were fracture healing.Damage control group was better than in the wound healing.Emergency surgery patients of fracture healing time was（15.0 ± 2.1） weeks.Injury control group（14.4 ± 2.8） weeks,emergency damage control surgery group with no significant difference in healing time（P 0.05）.Reference Ovadia on the healing of fractures of the tibia Pilon evaluation： emergency operation group were excellent in 7 cases,good in 10 cases,4 cases and poor in 1 case,the fine rate was 73.9%;damage control were excellent in 41 cases,good in 32 cases,and 8 cases and poor in 1 case,the fine rate was 89.0%,damage control was better than the emergency operation group（P0.05）.Conclusion：Damage control theory treatment of high energy tibial Pilon fractures,fewer complications,trauma,functional recovery,and recent results were satisfactory.