摘要
目的对Ruedi-AllogwerⅢ型pilon骨折患者对比分析分期切开复位内固定(分期ORIF)和外固定联合有限切开复位内固定2种治疗方法的临床疗效。方法方便选取2012年1月—2015年12月该所收治的70例pilon骨折患者,分别采用分期切开复位内固定(A组,35例)和外固定联合有限切开复位内固定(B组,35例)治疗,比较两组术后伤口感染率、骨折愈合时间、骨不愈合、Burwell-Charnley评分、Mazur踝关节评分。结果 A组伤口感染率8.60%。B组伤口感染率5.70%。两组在感染率方面差异无统计学意义(P>0.05)。两组患者骨折均获得骨性愈合,A组时间为为14~21周,平均16.6周;B组时间为13~19周,平均17.1周。两组在骨折不愈合,骨折愈合时间方面差异无统计学意义(P>0.05)。在术后踝关节功能恢复Mazur评分系统,A组优良率为:85.71%,B组优良率为:74.28%。两组在术后踝关节功能恢复方面差异无统计学意义(P>0.05),但两组优良率相差11.43%。在骨折复位Burwell-Charnley评分方面,A组复位可接受率为:97.14%;B组复位可接受率为:82.86%。A组Burwell-Charnley评分优于B组,并且差异有统计学意义(P<0.05)。骨折复位程度与踝关节功能恢复之间相关度为0.627(P<0.001),两者间有相关性并且差异有统计学意义(P<0.05)。结论对于闭合性、软组织条件较好的pilon骨折,正确把握手术时机,分期ORIF可以取得非常良好的临床效果。对于开放性骨折,软组织条件差的pilon骨折,采用外固定联合有限切开复位内固定,临床效果令人满意。
Objective To compare and analyze the clinical curative effect of staging open reduction and internal fixation and external fixation and limited open reduction internal fixation for patients with Ruedi-Allogwer III-type pilon fracture.Methods Convenient selection 70 cases of patients with pilon fracture admitted and treated in our hospital from January2012 to December 2015 were selected and divided into two groups with 35 cases in each, the group A adopted the staging open reduction and internal fixation, while the group B adopted the external fixation and limited open reduction internal fixation, and the infection rate of postoperative wound, fracture healing time, bone nonunion healing, Burwell-Charnley score and Mazur ankle joint score after operation were compared between the two groups. Results There was no statistical difference in the wound infection rate between the group A and group B（8.60% vs 5.70%）（P〉0.05）, and the fracture healing time in the group A was 14 to 21 weeks, 16.6 on average, in the group B was 13 to 19 weeks, 17.1 on average, and the differences in the bone nonunion healing and fracture healing time between the two groups were not statistically significant（P〉0.05）, and the excellent and good rate in the group A was 85.71% and 74.28% in the group B, and the difference in the recovery of postoperative ankle joint function between the two groups was not statistically significant（P〉0.05）, but the difference in the excellent and good rate between the two groups was 11.43%, the acceptability rate of reset in the group A and group B was respectively 97.14% and 82.86%, and the Burwell-Charnley score in the group A was better than that in the group B, and the difference was statistically significant（P〈0.05）, and the correlation degree between the fracture reset degree and ankle joint function recovery was 0.627（P〈0.001）, and the difference was statistically significant（P〈0.05）. Conclusion For closed pilon fracture with better soft tissue condition, the accurate mastery of operation opportunities and staging ORIF can obtain a very good clinical effect, for the open fracture or fracture with bad soft tissue conditions, the clinical effect of external fixation and limited open reduction is satisfactory.
出处
《中外医疗》
2017年第10期10-14,共5页
China & Foreign Medical Treatment
