两种不同术式治疗Pilon骨折的疗效比较分析

Comparison of two surgical methods in the treatment of Pilon fracture

目的探讨两种手术方式对Pilon骨折复位的效果及并发症的影响。方法选择77例Pilon骨折患者,分别采用两种手术方法进行治疗,其中采用分步延期ORIF法39例和有限内固定结合外固定支架法38例。术后采用Burwell-Charnley评价标准进行放射学的评价和Olerud-Molander评分标准进行临床疗效的评价,同时对并发症进行观察。结果在并发症方面,在术后8个月时,采用分步延期ORIF法的患者中,出现3例并发症;而采用有限内固定结合外固定支架法的患者中,出现9例并发症,两组比较差异有统计学意义(P<0.05)。在放射学评价方面,在术后8个月时,分步延期ORIF法中达到解剖复位为17例,功能复位18例,复位差3例;有限内固定结合外固定支架法达到解剖复位10例,功能复位16例,复位差9例,两组比较差异有统计学意义(P<0.05)。在临床疗效方面,分步延期ORIF法在上台阶、跑步、跳跃和支撑方面与B法比较,差异有统计学意义(P<0.05)。结论采用分步延期ORIF法治疗Ⅱ、Ⅲ型Pilon骨折,能有效维持解剖复位,减少术后并发症,并能达到较好的临床效果,值得推荐。

Objective To evaluate the influence of two surgical methods on the reduction effects and complications of Pilon fracture.Methods Seventy-seven patients with Pilon fracture were selected and divided into two groups.Patients in group A（n=39） underwent delay open reduction and internal fixation,while those in group B（n=38） were treated with limited internal fixation and external fixator.All the patients were followed up,and evaluated with the criteria of Burwell-Charnley and the criteria of Olerud-Molander.The complication was observed.Results Eight months of surgery,two patients in group A and 9 patients in group B had complications after,showing statistically significant difference between two group（P0.05）.In the criteria of Burwell-Charnley,group A was significantly better than group B（P0.05）.In the criteria of Olerud-Molander,group A was significantly better than group B in running,jumping and support and taking step（P0.05）.Conclusion For treating type Ⅱ and Ⅲ fracture,delay open reduction and internal fixation can maintain anatomical reduction and reduce postoperative complications,which can achieve better clinical results and should be recommended.