锁定钢板有限内固定结合中药外洗治疗Ⅲ型pilon骨折临床研究

Clinical Study of Type Ⅲ Pilon Fracture Treated with Limited Fixation by Locking Plate Combined with Traditional Chinese Medicine External Application

目的:探讨锁定钢板有限内固定结合中药外洗治疗Ⅲ型Pilon骨折的疗效。方法:2009年6月-2011年5月,共收治41例Ⅲ型Pilon骨折患者,随机分为2组,治疗组21例采用锁定钢板有限内固定结合中药外洗,对照组20例采用常规的切开复位解剖钢板内固定,比较2组在手术时间、术后骨折复位影像学评价、早期并发症、远期并发症、踝关节功能恢复等情况。结果:41例患者全部获得骨性愈合,随访时间10～20个月,平均15.6个月。手术时间治疗组平均67min,对照组平均95min;术后骨折复位影像学评价治疗组关节面解剖复位率为85.71%,对照组关节解剖复位率为65.00%;早期并发症治疗组9.52%,对照组30.00%;远期术后畸形愈合、延迟愈合、创伤性关节炎及关节僵硬等并发症治疗组14.21%,对照组35.00%。据Mazur标准,本组治疗组优良率为90.48%,对照组优良率为70.00%。结论:锁定钢板有限内固定结合中药外洗较单纯的切开复位解剖钢板内固定治疗Ⅲ型Pilon骨折手术时间短,早、远期并发症少,踝关节功能恢复好。

Objective：To explore the clinical efficacy of type Ⅲ Pilon fracture treated with limited fixation by locking plate combined with traditional Chinese Medicine external application.Methods：42 patients with Pion fracture classified as type Ⅲ were randomly divided into two groups：the control group and the experimental group,from Jun 2009 to May 2011.Patients in the experimental group were treated with internal fixation by locking compression plate and Chinese traditional medicine external application;patients in the control group were treated only with traditional open reduction and internal fixation.Time of operation,clinical results,quality of reduction of the articular surface,early-operative complications and post-operative complications were compared respectively between two groups.Results：The average time of flow-up was 15.6 months（ranged from 10 to 20 months）.Time of operation in the treatment was 67 min,95 min in the control group.The rates of anatomical reduction of the articular surface were 85.71% and 65%respectively in experimental group and the control group.The rates of early-operative complications were 9.52%and 30% respectively in experimental group and the control group.The rates of post-operative complications were 14.21%and 35%respectively in experimental group and the control group.The rates of clinical efficacy were 90.48% and 70% in the experimental group and the control group by the Mazur criteria.Conclusion：It had less time of operation,less early-operative and post-operative complications and better function of ankle joint for treatment type Ⅲ Pilon fracture with limited fixation by locking plate combined with traditional Chinese Medicine external application.