三种手术方式治疗ⅡⅢ型高能量胫骨pilon骨折的近远期疗效比较

Comparison of the Short-term and Long-term Effects of three Surgical methods in treating Type Ⅱ and Ⅲ High-energy Tibial Pilon Fractures

目的:比较分析三种不同手术方式治疗Ⅱ、Ⅲ型高能量胫骨pilon骨折的近远期疗效。方法:以我院2010年3月至2014年3月收治的103例Ⅱ、Ⅲ型高能量胫骨pilon骨折患者为研究对象,根据不同术式将其分为A组(一期切开复位内固定)、B组(有限内固定+外固定)与C组(分步延期手术),术后随访12~30个月,平均18个月,比较各组近远期疗效。结果:C组手术时间、术中出血量、骨折愈合时间、术后并发症总发生率均少于A组、B组,差异具有统计学意义(P<0.05);C组末次随访踝关节功能恢复优良率、总体健康、疼痛、活力、躯体功能及躯体角色评分均高于B组,差异具有统计学意义(P<0.05);A组末次随访踝关节功能恢复优良率、总体健康、疼痛、活力、躯体功能评分均高于B组,差异具有统计学意义(P<0.05)。结论:相比一期切开复位内固定、有限内固定+外固定,分步延期手术效果最佳,能显著降低并发症发生率,促进踝关节功能恢复,改善患者生活质量,可作为Ⅱ、Ⅲ型高能量胫骨pilon骨折治疗首选手术方案。

Objective： To compare the short-term and long-term effects of three surgical methods in treating type Ⅱ and Ⅲ high-energy tibial pilon fractures.Methods： 103 patients with type Ⅱ and Ⅲ high-energy tibial pilon fractures treated in our hospital between March 2010 to March 2014 were selected as study subjects,and according to different surgical methods,they were divided into group A （one-stage open reduction and internal fixation）,group B （limited internal fixation and external fixation） and group C （stepwise delayed surgery）.All patients were followed up for 12 ～ 30 months with an average of 18 months.The short-term and long-term effects were compared between groups.Results： The operation time,intraoperative blood loss,fracture healing time and incidence of postoperative complications in group C were significantly less and lower than those in group A and group B （P〈0.05）; The excellent and good rate of ankle functional recovery,scores of overall health,pain,vitality,physical function and physical role in group C were significantly higher than those in group B （P〈0.05）,and those in group A were significantly higher than those in group B at the end of follow-up （P〈0.05）.Conclusion： Compared with one-stage open reduction and internal fixation,limited internal fixation and external fixation,the effect of stepwise delayed surgery is the best which can significantly reduce the incidence of complications,promote the recovery of ankle joint function,improve the quality of life of patients,and can be used as the preferred surgery for treating type Ⅱ and Ⅲ high-energy tibial pilon fractures.