分步延期手术与早期切开复位内固定手术治疗高能量Pilon骨折对照研究

Comparative study of fractional delay operation and early incision internal fixation operation in treatment of high energy Pilon fracture

目的研究分步延期手术与早期切开复位内固定手术治疗高能量Pilon骨折的疗效。方法将2011年9月-2013年9月成都市第六人民医院骨科收治好的Plion骨折患者纳入研究，根据手术方法不同分为分步延期手术治疗观察组和早期切开复位内固定手术对照组，比较两组患者的手术指标、应激反应指标以及骨折愈合情况。结果观察组患者的手术时间（47．8±7．2）min、术中出血量（34．4±5．1）mL、卧床时间（4．7±0．6）d、住院总时间（8．3±1．1）d以及肾上腺素（98．4±12．2）ng／mL、去甲肾上腺素（103．5±15．3）ng／mL、肾素（2．4±0．4）pg／mL、血管紧张素Ⅱ（28．2±5．6）pg／mL、影像学完全愈合时间（118．7±15．2）d、完全负重下地时（162．9±23．1）d均低于对照组；术后4、8及12月时，观察组患者的Baird踝关节评分[（85．4±13．2）、（89．2±12．6）、（96．2±13．2）]均高于对照组。结论分步延期手术能够减小手术创伤、缓解应激反应、促进骨折愈合、改善踝关节功能，是治疗高能量Pilon骨折的理想方法。

[ Objective ] To study the effect of fractional delay operation and earlyincision internal fixation operation in treating high energy Pilon fracture. [Methods ] Pilon fracture patients in our hospital from 2011 September to 2013 September were enrolled and divided into observation group given fractional delay operation and control group given early incision internal fixation operation. Then operation index, stress reaction index, fracture healing condition of two groups were compared. [ Results ] Operation time （47.8±7.2） rain, intraoperative blood loss （34.4±5.1） mL, bed time （4.7±0.6） d, hospitalization time （8.3±1.1） d, epinephrine （98.4±12.2） ng/mL, norepinephrine （103.5±15.3） ng/ mL, rennin （2.4±0.4） pg/mL, angiotensin Ⅱ （28.2±5.6） pg/mL and radiological complete healing time （118.7±15.2） d, completely weight-bearing time （162.9±23.1） d of observation group were lower than control group; 4, 8, 12 months after operation, Baird ankle join1 scores （85.4±13.2）, （89.2±12.6）, （96.2±13.2） of observation group were higher than control group. [ Conclusions ] Fractional delay operation is an ideal method in treating high energy Pilon fracture for it can promote healing, relieve stress reaction, improve ankle joint function.