延期手术和非延期手术治疗Pilon骨折的临床效果比较

Clinical effects of delayed operation and non-delayed operation on Pilon fracture

目的 比较延期手术和非延期手术治疗Pilon骨折的临床效果。方法 选取2005年3月至2015年3月江苏省昆山市第四人民医院和苏州大学附属第一医院收治的Rüedi-AllgwerⅡ型、Ⅲ型Pilon骨折患者45例为研究对象。按照拟行手术时机将患者分为延期手术治疗组（25例）和非延期手术治疗组（20例）。延期手术治疗组早期理疗，伤后7-16 d伤口愈合，出现皮肤皱褶后方行手术治疗；非延期手术治疗行急诊清创术，不延期手术复位。比较2组骨性愈合时间、临床疗效和并发症发生情况。结果 延期手术治疗组愈合时间短于非延期手术治疗组［（17±3）周比（22±4）周］，延期手术治疗组踝关节症状与功能评分系统评估优良率高于非延期手术治疗组［92.0%（23/25）比60.0%（12/20）］，差异均有统计学意义（均P〈0.05）。延期手术治疗组术后无皮肤感染、坏死等并发症发生。非延期手术治疗组有2例发生皮肤感染；延期手术治疗组并发症发生率低于非延期手术治疗组，差异有统计学意义［0.0%（0/25）比10.0%（2/20）］（P〈0.05）。结论 延期切开复位内固定治疗Pilon骨折效果优于非延期手术治疗。

Objective To analyze the clinical effects of delayed operation and non-delayed operation on Pilon fracture. Methods Totally 45 cases of Pilon fracture（Rüedi-Allgwer Ⅱ, Ⅲ） from March 2005 to March 2015 in Kunshan Fourth People′s Hospital and the First Affiliated Hospital of Soochow University were enrolled. According to the time of operation, all patients were divided into delayed operation group（25 cases） and non-delayed operation group（20 cases）. The delayed operation group was treated with early physical therapy, the operation was performed when skin creases appeared after 7-16 days of wound healing. The non-delayed operation group was treated with emergency debridement. Bone union time, clinical efficacy and complications were analyzed. Results The bone union time in delayed operation group was significantly shorter than that in non-delayed operation group[（17±3）weeks vs （22±4）weeks]（P〈0.05）. The excellent rate of ankle joint symptom and function score system in delayed operation group was significantly higher than that in non-delayed operation group[92.0%（23/25） vs 60.0%（12/20）]（P〈0.05）. No complication was observed in delayed operation group, non-delayed operation group had 2 cases of skin infection; the complication incidence in delayed operation group was significantly lower than that in non-delayed operation group[0.0%（0/25） vs 10.0%（2/20）]（P〈0.05）. Conclusions Delayed operation treating Pilon fracture is effective than non-delayed operation.