混合固定治疗47例Pilon骨折的效果观察

Effect observation of mixed fixation in the treatment of 47 cases of pilon fracture

目的 探讨混合固定治疗47例Pilon骨折的临床疗效。方法 选取2014年1月~2015年2月期间高要区中医院骨科收治的Pilon骨折94例,并按照随机数字表法分为对照组（n=47）和观察组（n=47）。观察组行混合固定治疗,对照组行切开复位内固定法治疗,对比两组的治疗效果。结果 观察组患者术后并发症为10.6%,显著少于对照组的29.8%（P〈0.05）。术后3个月,观察组、对照组在解剖复位、复位可和复位差方面相比较,差异无统计学意义（P〉0.05）。术后随访1年,观察组Ⅲ型骨折Mazur评分均显著高于对照组（P〈0.05）,对照组Ⅱ型骨折Mazur评分显著高于观察组（P〈0.05）。结论 在Pilon骨折治疗中,混合固定法可以有效地改善踝关节功能,术后并发症少。对于Ⅱ型Pilon骨折建议采用有限内固定治疗,Ⅰ型和Ⅲ型Pilon骨折建议采用混合固定。

Objective To investigate the clinical effect of mixed fixation in the treatment of 47 cases of Pilon fracture. Methods 94 cases of Pilon fracture cured in our hospital from January 2014 to February 2015 were selected and divided into control group and observation group with 47 cases in each. Patients in observation group were treated with mixed fixation, while patients in control group were treated with open reduction and internal fixation. Results The postoperative complications of the observation group was 10.6%, which was significantly less than that of control group with 29.8%（P 〈 0.05）. 3 months after surgery, the anatomical reduction, good reduction and poor reduction of two groups had no significant difference（P 〉 0.05）. After 1 years of follow-up, the Mazur score of Type III in observation group was significantly higher than that in control group （P 〈 0.05）, the Mazur score of Type Ⅱ in control group was significantly higher than that in observation group（P 〈 0.05）, and the Mazur score of Type Ⅱ in two groups had no significant difference（P 〉 0.05）. Conclusion The mixed fixation method can effectively improve the function of the ankle joint, and it has less complications. The limited internal fixation is recommended for the type Ⅱ , and the mixed fixation is recommended for the type I and type III.