高压氧辅助治疗pilon骨折术后愈合效果分析

Analysis on the therapeutic effect of accessory hyperbaric oxygen therapy on pilon fracture following internal fixation

目的研究高压氧（hyperbaricoxygen，HBO）辅助治疗Pilon骨折切开内固定术后愈合的临床疗效。方法选择Pilon骨折内固定术后患者180例，按数字表法将180例患者分为术后1d高压氧（高压氧1）、5d（高压氧2）治疗组及常规组，每组60人。常规组术后给予常规治疗（即用抗生素、扩血管药、抗凝药治疗，并行局部换药及对症处理），治疗组在上述治疗基础上分别于术后1d．5d辅以高压氧治疗。观察软组织肿胀消失时问、骨折线模糊时间、骨折线消失时间及出现并发症情况。结果治疗后高压氧1组和2组软组织肿胀消失时间、切口愈合时间、平均骨折线模糊时间和平均骨折线消失时间分别为（5．2±0．8）d、（8．1±0．6）d、（2．9±0．4）个月和（13．4±0．6）个月、（7．2±0．9）d、（9．5±0．5）d、（3．1±0．5）个月和（13．8±0．4）个月，明显优于常规组[（10．0±1．3）d、（10．9±0．6）d、（3．8±0．5）个月和（15．6±0．6）个月]（P〈0．01），高压氧1组优于高压氧2组（P〈0．01）。结论Pilon骨折术后行高压氧治疗可促进伤口和骨骼早日愈合，减少并发症的发生，数据显示选择术后早期高压氧治疗效果更佳。

Objective To investigate the therapeutic effect of HBO on pilon fracture following internal fixation. Methods One hundred and eighty patients with pilon fracture after internal fixation were divided into 3 groups ： the HBO therapy one day after surgery group （ the HBO therapy group 1 ） , the HBO therapy fives days after surgery group （the HBO therapy group 2） and the routine treatment group （ or the control group）. The patients in the control group were given routine treatment （administration of antibiotics, vascular dilation drugs, anticoagulants and expectant treatment）. The patients in the HBO group were given HBO therapy one day and five days after surgery, in addition to routine treatment mentioned above. Then, observations were made on the times of soft tissues detumescence, wound healing, average fracture line, average fracture line disappearance and occurrence of complications. Results Following treatment, the times of soft tissues detumescence, wound healing, average fracture line, average fracture line disappearance for group 1 were （5.2 ± 0.8 ） d, （ 8.1 ± 0.6） d, （2.9 ± 0.4） mon and （ 13.4 ± 0. 6） mon, and the times for group 2 were （7.2 ± 0.9 ） d, （9.5 ＋ 0.5 ） d, （ 3.1 ± 0.5 ） mon and （ 13.8 ±0.4） mon respectively, which were obviously superior to those of the control group [ （10.0±1.3）d,（10.9±0.6）d,（3.8±0.5）mon and（15.6±0.6）mon]（P〈 0.01 ）. And the therapeutic effect for group 1 was better than that for group 2 （ P 〈 0.01 ）. Conclusions Following internal fixation, HBO therapy could promote wound and pilon fracture healing with less complications and better therapeutic effects. Early HBO therapy after surgery could produce much better therapeutic effects.