胫骨Pilon骨折不同时间窗行切开复位内固定的近远期疗效观察

Observation of short-term and long-term effect of open reduction internal fixation in treating tibial Pilon fractures at different time windows

目的观察胫骨Pilon骨折不同时间窗行切开复位内固定的近远期疗效。方法选择咸阳市第一人民医院骨科2012年3月—2014年5月收治的114例胫骨Pilon骨折患者,根据伤后至手术时间分为A组、B组与C组,各38例。三组患者均采取切开复位内固定,其中A组手术时间为伤后6h内,B组为伤后6h^6d,C组为伤后7~14d。比较三组骨折愈合时间、骨折完全愈合率、复位满意率、术后并发症总发生率、术后3年的踝关节功能优良率。结果 A组与C组骨折愈合时间相当,分别为(11.55±3.24)周、(11.16±3.44)周,短于B组(14.20±3.68)周(P<0.05)。三组骨折愈合情况比较差异无统计学意义(P>0.05),复位率的差异无统计意义(P>0.05)。A组与C组的术后并发症总发生率分别为10.53%与7.89%,低于B组28.95%,但差异无统计学意义(P>0.017)。A、B、C组术后3年的踝关节功能优良率分别为89.47%、84.21%、86.85%,差异无统计学意义(P>0.05)。结论胫骨Pilon骨折患者伤后6h内及7~14d软组织无明显肿胀,伤口张力小,该时间窗采取切开复位内固定利于骨折复位与愈合及并发症的减少,可取得良好预后。

Objective To observe the short-term and long-term effect of open reduction and internal fixation in treating tibial Pilon fractures at different time windows. Methods Totally 114 cases of tibial Pilon fracture treated in the Department of Orthopedics of the First People＇s Hospital of Xianyang from Mar. 2012 to May 2014 were selected and divided into group A,group B and group C,with 38 cases in each group. Three groups of patients were all treated with open reduction and internal fixation. Patients in group A were operated within 6 hours after injury,6 hours to 6 days after injury in group B,and 7 to 14 days after injury in group C. The fracture healing time,complete fracture healing rate,reduction satisfaction rate,the total incidence of postoperative complications and the excellent and good rate of ankle function at 3 years after operation were compared among three groups. Results The fracture healing time in group A and group C was（ 11. 55 ± 3. 24） weeks and（ 11. 16 ± 3. 44） weeks,which were both shorter than（ 14. 20 ± 3. 68） weeks in group B（ P〈0. 05）. There was no significant difference in fracture healing among the three groups（ P〉0. 05）. There were no significant difference in reset satisfaction rate among the three groups（ P〉0. 05）. The total incidence of postoperative complications in group A and group C was 10. 53%and 7. 89%,respectively,slightly lower than that in group B（ 28. 95%）,but the difference was not statistically significant（ P〉0. 017）. The excellent and good rate of ankle function at 3 years after operation in group A,B and C was 89. 47%,84. 21% and 86. 85%,respectively,and the difference was not statistically significant（ P〉0. 05）.Conclusion Tibial Pilon fracture patients have no obvious soft tissue swelling and wound tension is small within 6 hours and 7-14 days after injury. Applying open reduction and internal fixation in these time windows helps fracture reduction and healing and reduces complications,and can achieve good prognosis.