外固定架与跟骨牵引早期处理严重Pilon骨折的比较研究

Comparison study between external fixator and traction of calcaneus dealing with severe Pilon fracture in the early stage

目的比较应用外固定架与跟骨牵引早期处理严重Pilon骨折的效果。方法自2008-07—2010-12收治严重Pilon骨折56例,骨折按Ruedi-Allgower分型均为Ⅲ型。其中32例急诊采用临时外固定架固定(外固定架组),24例采取跟骨牵引外加石膏外固定(跟骨牵引组)。观察2组肢体肿胀程度、距二期切开手术时间、VAS评分。结果外固定架组Ⅱ度、Ⅲ度肿胀消退有效率分别为89.5%、92.3%,跟骨牵引组的有效率分别为58.3%及50.0%;外固定架组距离二期手术时间平均(9.2±1.3)d,跟骨牵引组平均(10.3±1.2)d;外固定架组急诊术后24 h、3 d及7 d VAS评分分别为(7.13±1.46)、(5.29±1.66)、(4.32±1.22)分,跟骨牵引组分别为(8.25±1.24)、(6.31±1.32)、(5.13±1.13)分;外固定架组在以上3个方面均优于跟骨牵引组,差异有统计学意义(P<0.05)。结论对于严重Pilon骨折,早期应用临时外固定架固定能够有助于患肢消肿,减轻疼痛,缩短住院时间,减少软组织并发症,并且在一定程度上简化二期手术。

Objective To compare the effect of the external fixator and traction of calcaneus in the early treatment of severe Pilon fracture. Methods From July 2008 to December 2010 fifty six patients with Ruedi-Allgower type Ⅲ Pilon fractures were treated. There were 32 cases in external fixator group. And there were 24 cases in calcaneus traction group. The limb swelling degree, time space between two stage surgery, and VAS scores between the two groups were observed. Results The Ⅱ° and Ⅲ° swelling effective rate of the external fixation group was 89.5%, 92.3%. The Ⅱ° and Ⅲ° swelling effective rate of the calcaneus traction group was 58.3% and 50.0%（P〈 0.05）; The average time space between two stage surgery was（9.2±1.3）day for external fixation group and（10.3±1.2）day for calcaneus traction group（P 0.05）; the VAS scores for external fixation group was significantly different from the calcaneus traction group, the frontier is much better（P〈0.05）. Conclusion External fixator is effective in the early treatment of Pilon fracture with more stable fixation,helpful for the subsiding swelling,alleviating the pain, reducing the length of stay and the soft tissue complication effectively, so we advocate using the external fixator dealing with severe Pilon fracture in the early stage.