高能量Pilon骨折患者应用分步延期手术临床可行性研究

Clinical feasibility of staged delayed surgery for patients with high energy Pilon fractures

目的探讨高能量Pilon骨折患者应用分步延期手术临床可行性研究。方法将笔者所在医院骨科收治的Pilon骨折患者70例，按不同手术方法分为对照组（早期切开复位内固定）和观察组（分步延期手术），记录两组患者住院时间、卧床时间、手术用时、术中出血量，记录血管紧张素Ⅱ（ATII）、肾素（R）、去肾上腺素（NE）、肾上腺素（E）等应急指标水平，观察术后3个月、8个月、12个月踝关节评分，记录完全负重下地时间及影像学下骨折愈合时间。结果与对照组比较，观察组患者住院时间、手术用时、卧床时间均更短，术中出血量更少；观察组ATII、R、NE、E水平明显更低；术后3个月、8个月、12个月时观察组踝关节评分不断提高并高于对照组；观察组完全负重下地时间为（164．20±20．31）d，影像学下骨折愈合时间为（110．25±13．12）d，均早于对照组；均P〈0．05。结论高能量Pilon骨折患者应用分步延期手术可缩短手术操作时间，减少创伤和应激反应，从而使患者更早下床活动，加快踝关节功能改善，应用分步延期手术可在高能量Pilon骨折治疗中推广。

Objective To investigate the feasibility of staged delayed surgery for patients with high energy Pilon fractures. Methods 70 patients with Pilon fracture treated at our department were divided into a control group, treated with early open reduction and internal fixation, and an observation group, treated with staged delayed surgery. The hospital stay, time for being ill in bed, operation time, intra-operative bleeding volume, and levels of angiotensin II （ATII）, renin （R）, norepinephrine （NE）, epinephrine （E）, etc. were recorded. 3, 8, and 12 months after the operation, the ankle joint scores were observed. The iconographic fracture healing time and time for weight-bearing were recorded. Results The hospital stay, time for being ill in bed, and operation time were shorter and the intra-operative bleeding volume was lower in the observation group than in the control group. The levels of ATII, R, NE, and E were significantly lower in the observation group than in the control group. 3, 8, and 12 months after the operation, the ankle joint scores were higher in the observation group than in the control group. The iconographic fracture healing time and time for weight-bearing were （ 110.25~13.12 ） d and （ 164.20-~20.31 ） d in the observation group, which were shorter than those in the control group. Conclusions Staged delayed surgery for high energy Pilon fractures can shorten operation time, reduce trauma and stress, and accelerate ankle joint function improvement, so that the patients can have early postoperative ambulation, so it is worth being generalized.