外固定支架联合有限内固定与腓骨重建钢板治疗老年Pilon骨折效果分析

Clinical effect of external fixator combined with limited internal fixation and fibular reconstruction plate in elderly patients with Pilon fracture

目的探讨外固定支架联合有限内固定与腓骨重建钢板治疗老年Pilon骨折的效果。方法选择2014年9月至2016年6月本院收治的老年Pilon骨折患者82例为研究对象。按照随机数表法将入选患者分为观察组和对照组,每组各41例。观察组患者给予外固定支架联合有限内固定与腓骨重建钢板治疗,对照组患者给予传统切开复位内固定术治疗。比较两组患者骨折愈合时间、手术时间、术中出血量,记录患者治疗前后踝穴高度、宽度、深度、冠状位角度、矢状位角度变化及踝关节Kofoed评分,参照Burwell Chamley提出的骨折复位影像学标准和Tornetta等提出的Pilon骨折愈合标准分别对两组患者治疗前后进行放射学和临床疗效评估。结果观察组患者手术时间和骨折愈合时间均显著短于对照组(P<0.05),术中出血量显著少于对照组(P<0.05)。治疗后,两组患者踝穴高度、宽度、深度、冠状位角度及矢状位角度较治疗前均显著降低(P<0.05);观察组患者踝穴宽度、深度、冠状位角度及矢状位角度改善更明显(P<0.05),两组患者踝穴高度比较无显著差异(P>0.05)。治疗后,两组患者踝关节疼痛评分、踝关节功能评分及踝关节活动度评分均显著高于治疗前(P<0.05),且观察组患者上述指标均显著高于对照组(P<0.05)。观察组患者治疗优良率显著高于对照组(P<0.05),复位情况(解剖复位+一般复位)明显优于对照组(P<0.05)。观察组患者并发症发生率显著低于对照组(χ~2=8.289,P<0.05)。结论外固定支架联合有限内固定与腓骨重建钢板治疗老年Pilon骨折,患者愈合快,并发症少,可显著改善其踝关节功能,是一种安全有效的治疗方式。

Objective To investigate the clinical efficacy of external fixator combined with limited internalfixation and fibular reconstruction plate in elderly patients with Pilon fracture.Method82cases of elderly patients with Pilon fracture were selected as the research object from September2014to June2016in our hospital.The selected patients were randomly divided into observation group and control group,41cases in each group.Observation group patients were treated with external fixator combined with limited internal fixation and fibular reconstruction plate,while control group patients were treated with traditional open reduction and internal fixation.The fracture healing time,operation time,amount of bleeding during operation were compared between the two groups,the ankle height,width,depth,coronal and sagittal angle and ankle joint Kofoed score of patients were recorded before and after treatment,the therapeutic effects were evaluated by Burwell Chamley imaging and Tornetta standards.Result The operation time and fracture healing time of observation group were significantly shorter than control group(P<0.05),and the amount of bleeding during operation was significantly less than that of control group(P<0.05).After treatment,the ankle height,width,depth,coronal and sagittal angle of the two groups were significantly lower than before treatment(P<0.05);the ankle width,depth,coronal and sagittal angle of observation group of patients improved significantly(P<0.05),there was no significant difference in ankle cavity height between the two groups(P>0.05).After treatment,the ankle joint pain score,ankle function score and ankle joint activity score of the two groups of patients were significantly higher than those before treatment(P<0.05),and the above indexes of observation group were significantly higher than control group(P<0.05).The excellent and good rate of treatment in observation group was significantly higher than control group(P<0.05),and the reduction(anatomical reduction+general reduction)was significantly better than control group(P<0.05).The incidence of complications in observation group was significantly lower than control group(χ2=8.289,P<0.05).Conclusion It is safe and effective to use external fixator combined with limited internal fixation and fibular reconstruction plate in elderly patients with Pilon fracture which has fast healing and less complications,and can significantly improve the ankle function.