高能量胫骨Pilon骨折手术方式的选择与治疗效果相关因素分析

Selection of operation mode in treating high energy tibial pilon fractures and analysis of treatment effect related factors

目的分析高能量胫骨Pilon骨折手术方式的选择与治疗效果的相关因素,为临床选择合理手术方式提供参考。方法将2012年9月—2013年8月期间台州市中心医院骨科接受分步延期手术治疗的290例高能量胫骨Plion骨折患者纳入观察组,2011年8月—2012年8月期间接受早期切口复位内固定治疗的290例高能量胫骨Plion骨折患者纳入研究的对照组,比较2组患者的骨折愈合时间、不愈合的发生率,分析治疗效果的相关因素,采用SPSS 16.0进行统计分析,单因素分析采用χ2检验,多因素分析采用二分类logistic回归分析。结果 1观察组患者的影像学完全愈合时间(116.7±15.2)d、完全负重下地时间(161.9±23.1)d、并发骨折不愈合(7.24%)均明显低于对照组(t/χ2=7.094、6.234、9.166,P<0.05);2单因素分析显示不同年龄、骨折类型、手术方式、术中操作情况、并发感染情况以及合并骨质疏松、糖尿病情况的患者,骨折不愈合的发生率差异有统计学意义(χ2=22.078、56.023、86.910、45.835、18.698、47.397、12.629,P<0.01);3高龄、Ⅲ型、早期切开复位、忽略小骨块处理、并发感染、合并骨质疏松和糖尿病是发生骨折不愈合的危险因素(r=3.611、3.878、3.274、2.904、2.984、3.094、3.764,P<0.05)。结论分步延期手术能够促进骨折愈合、预防骨折不愈合的并发症,整体治疗效果受到患者自身情况、骨折类型、手术操作情况等多种因素的影响,应准确把握危险因素并进行预防。

Objective To explore the selection of operation mode in treating high energy tibial Pilon fractures and treat- ment effect related factors, and to provide reference for clinical reasonable operation method. Methods 290 cases of high energy Pilon fracture patients received fractional delay operation in our hospital from 2012 September to 2013 August were enrolled in observation group and patients received early incision internal fixation operation from 2011 August to 2013 Au- gust were enrolled in control group. Then fracture healing time and incidence of nonunion were compared, treatment effect related factors were analyzed. Used SPSS 16.0 statistical analysis, single factor analysis used chi-square, multi-factor anal- ysis using binary classification logistic regression analysis. Results ①radiographic healing time in observation group was （ 116.7 ± 15.2） d,full load time was（ 161.9 ±23.1 ） d,fracture nonunion （7.24%） were significantly lower than those of control group（ t/χ2 = 7. 094,6. 234,9. 166, P 〈 0. 05 ） ; ②single factor analysis showed that there were statistical differ- ence of fracture nonunion rate between patients with different age, fracture type, operation mode, operation condition, infec- tion eases, complicated with osteoporosis and diabetes （χ2 = 22. 078,56. 023,86.910, 45. 835,18. 698,47. 397,12. 629, P 〈 0. 01 ） ;③logistic regression analysis showed that old age, early incision internal fixation, ignoring the small bone, complicated with infection and osteoporosis, diabetes were risk factors of fracture nonunion （r = 3. 611,3. 878,3. 274, 2.904,2.984,3. 094,3. 764,P 〈 0.05 ）. Conclusion Fractional delay operation can promote healing and prevent frac- ture nonunion; treatment effect was affected by patient ＇ s own situation, operation situation, we should accurately grasp the risk factors and prevent fracture nonunion.