切开复位内固定与有限内固定结合外固定治疗胫骨Pilon骨折的对比研究

Comparative study of open reduction and internal fixation versus external fixation combined with limited internal fixation in the treatment of Pilon fractures

目的比较切开复位内固定与有限内固定结合外固定治疗胫骨Pilon骨折的疗效。方法将76例经X线或CT证实的胫骨Pilon骨折患者随机分为研究组(n=38,接受有限内固定结合外固定架治疗)和对照组(n=38,接受切开复位内固定术),比较两组骨折愈合时间、患者术后踝关节功能恢复情况及并发症发生情况。结果研究组平均骨折愈合时间[(5.9±0.6)个月]较对照组[(5.2±0.4)个月]稍长,但差异无统计学意义(P>0.05);两组患者术后踝关节功能均得到恢复,但研究组疗效优良率(84.21%)显著高于对照组(68.42%)(P<0.05);研究组并发症发生率为15.79%(6/38),显著低于对照组的28.95%(11/38)(P<0.05),其中软组织感染发生率较对照组高(P<0.05),骨髓炎及骨折畸形愈合发生率较对照组低(P<0.05),关节融合发生率差异无统计学意义(P>0.05)。结论有限内固定结合外固定治疗胫骨Pilon骨折操作简单、安全,并发症少,可获得较好的踝关节功能和预后,值得临床推广应用。

Objective To compare the efficacy of open reduction and internal fixation versus external fixation combined with limited internal fixation in the treatment of Pilon fractures. Methods 76 patients with Pilon fractures confirmed by X- ray or CT were divided into study group （n = 38, received external fixation combined with limited internal fixation） and control group （n = 38, received open reduction and internal fixation） at random, the fracture healing time, postoperative ankle joint function recovery and complications of the two groups were compared. Results The mean fracture healing time of study group was （5.9±0.6） months, slightly longer than control group of （5.2 ±0.4） months, but no statistical difference was observed （P 〉 0.05）. The ankle joint function of both groups was well recovered, but the good rate of study group （84.21%） was significantly higher than control group （68.42%） （P 〈 0.05）. The complication incidence of study group was 15.79% （6/ 38）, which was statistically higher than control group [28.95% （11/38）] （P 〈 0.05）, and the incidence of soft tissue infection was higher than control group （P 〈 0.05）, the incidences of osteomyelitis and malunion were lower than control group （P 〈 0.05）, and the incidences of joint fusion were equal in two groups （P 〉 0.05）. Conclusion External fixation combined with limited internal fixation is simple and safe with less complications in treating Pilon fractures, and it can obtain good ankle joint function prognosis, thus it is worthy of extensive applied in clinic.