Pilon骨折一期闭合复位外固定支架固定术后骨折复位良好患者后续治疗方法的选择

Consequent treatment after one-stage close reduction with external fixation in Pilon fracture patients with good fracture reduction

目的 探讨Pilon骨折一期闭合复位外固定支架固定术后骨折复位良好患者后续治疗方法的选择.方法 选择复旦大学附属中山医院青浦分院2006年1月至2012年6月行一期闭合复位外固定支架固定术后骨折复位良好的Pilon骨折患者36例,根据后续治疗方案将患者完全随机分为未更换内固定组和更换内固定组,各18例.未更换内固定组未行二期更换内固定手术治疗,更换内固定组在术后2周左右行拆除外固定支架更换内固定手术.术后随访,观察2组患者并发症发生情况并于末次随访时评价患者踝关节功能.结果 术后随访13 ～35个月,未更换内固定组发生钉道感染1例,无皮肤坏死、神经血管损伤并发症;更换内固定组出现皮肤部分坏死3例.未更换内固定组末次随访时踝关节功能评分与更换内固定组比较[（91.6±2.3）分比（92.3±2.7）分],差异无统计学意义（P＞0.05）.结论 对于闭合复位外固定支架固定治疗的Pilon骨折患者,如果骨折复位满意,可以选择不更换内固定,将外固定支架固定作为确定性治疗.

Objective To investigate the choice of consequent treatment after one-stage close reduction with external fixation in Pilon fracture patients with good fracture reduction.Methods Totally 36 patients with Pilon fracture who obtained good postoperative fracture reduction after one-stage close reduction with external fixation from January.2006 to June 2012 were enrolled and divided into non-internal fixation group and internal fixation group according to the follow-up treatment （18 cases in each group）.In non-internal fixation group,two-stage internal fixation was not performed;in internal fixation group,the external fixation was remove and two-stage internal fixation was performed 2 weeks after external fixation.The complications were observed and the ankle joint function at the last follow-up was assessed.Results The patients were followed up for 13-35 months.In non-internal fixation group,pin tract infection occurred in 1 case,no skin necrosis,complications of nerve and blood vessel injury occurred;in internal fixation group,partial necrosis of skin occurred in 3 cases.The ankle joint function score at the last follow-up was not significantly different between groups [（91.6 ± 2.3） scores vs （92.3 ± 2.7） scores] （P 〉0.05）.Conclusion In patients with Pilon fracture,if the fracture reduction is satisfied after closed reduction with external fixation,it is optional not to replace external fixation with internal fixation and take external fixation as the definitive treatment.