延期切开复位内固定治疗胫骨Pilon骨折的可行性及价值研究

Study on the Feasibility and Value of Delayed Open Reduction and Internal Fixation for the Treatment of Tibia Pilon Fracture

目的探究对胫骨骨折患者行延期切开复位内固定治疗的可行性及价值,以期为胫骨Pilon骨折的临床治疗提供参考。方法方便选取2015年11月—2016年11月该院骨科收治的112例胫骨Pilon骨折患者,随机分成两组,每组56例,研究组行以延期切开复位内固定治疗,对照组行早期切开复位内固定治疗,通过Helfet评分、Mazur评分评价所选患者的临床效果。结果对照组利用Mazur评分对56例患者进行评估,评分均值为(53.38±5.17)分,研究组利用Mazur评分对56例患者进行评估,评分均值为(85.44±6.67)分,两组比较差异有统计学意义(t=28.429,P=0.000,P<0.05);对所选患者术后行为期13个月的随访,采用Helfet评分对患者进行评估,并与影像学资料相结合,研究组患者中36例治疗结果为优(64.29%)、15例治疗结果为良(26.79%)、5例治疗结果为差(8.93%),总优良率为91.07%,对照组患者中25例治疗结果为优(44.64%)、18例治疗结果为良(32.14%)、13例治疗结果为差(23.21%),总优良率为76.79%;术后两组患者出现不同程度的关节僵硬、踝关节内翻、继发性感染、骨折愈合延迟等并发症,经过对症治疗,并发症均得到康复。结论对胫骨骨折患者行延期切开复位内固定治疗可取得确切效果,该术式不仅对患者术后恢复有改善作用,而且不会出现严重并发症,临床价值显著,值得推广。

Objective To explore the feasibility and value of delayed open reduction and internal fixation treatment of tibia pilon fracture,aiming to provide reference to tibia pilion fracture clinical treatment.Methods 112 cases of tibial pilon patients from November 2015 to November 2016 in our hospital were convenient selected and randomly divided into two groups,56 case in each group,study group underwent the delayed open reduction and internal fixation,and the control group underwent early open reduction and internal fixation.The clinical effect of selected patients was evaluated by Helfet score and Mazur score.Results In the control group,the average Mazur score of 58 patients was(53.38±5.17)points while in the study group it was(85.44±6.67)points in 56 patients.The comparison between the two groups had statistical difference(t=28.429,P=0.000,P<0.05);Post-operation behavior of selected patients after 13 months of follow-up,the patients were evaluated by Helfet score.And combining with iconography.36 cases of patients in the study group had excellent results(64.29%),15 cases of patients had good results(26.79%)and 5 cases of patients had bad results(8.93%),total the excellent rate was 91.07%.In the control group,25 cases treated as excellent results(44.64%),18 cases as good(32.14%),13 cases as bad(23.21%),the total excellent rate was 76.79%;two groups of patients got varying degrees of the postoperative complications such as joint stiffness,ankle varus,secondary infection and fracture healing delay,which recovered after symptomatic treatment.Conclusion The effect of postoperative reduction and internal fixation on tibia pilon fractures can be improved.The procedure not only improves the postoperative recovery,but also has no serious complication.The clinical value is remarkable.So it is worthy of promotion.