开放性AO-C3型pilon骨折治疗方式的选择

Selection of the Treatment Modalities for Open Type AO-C3 Pilon Fracture

目的探讨开放性AO-C3型pilon骨折行切开复位内固定手术(open reduction and internal fixation,ORIF)的方式和时机的选择。方法对比分析2012年7月至2018年7月山西医科大学第二医院骨科46例开放性AO-C3型pilon骨折患者不同时间段、不同方式行ORIF的临床资料,根据手术方式的不同分为两组:A组:伤后6h内行急诊手术,手术方式为伤口彻底清创后行有限切开复位内固定结合外固定支架治疗,共18例;B组:伤后先给与清创缝合、消肿、预防感染、跟骨牵引或石膏外固定,于7~15d软组织恢复良好后行ORIF,手术方式为复位后1/3管型钢板固定腓骨、复位并植骨后固定胫骨远端和下胫腓联合,共28例。比较两组术后骨折复位质量、伤口并发症发生率、骨折愈合时间、Bourne标准踝关节功能评分。结果B组在Burwell-Charnley评分、骨折畸形愈合、伤口并发症发生率方面优于A组,差异有统计学意义(P<0.05)。两组在骨折愈合时间和Bourne踝关节功能评分方面比较,差异无统计学意义(P>0.05)。结论对于开放性AO-C3型pilon骨折,伤后6h内行急诊手术和清创后二期手术均是其较好的治疗方法,但清创后二期手术可提高骨折解剖复位率,降低伤口并发症的发生率,从而降低手术及住院风险。

Objective To explore the method and timing of open reduction and internal fixation (ORIF) for open AO-C3 Pilon fracture.Methods The clinical data of 46 patients with open AO-C3 Pilon fracture undergoing ORIF of different ways at different time from July of 2012 to July of 2018 in Second Hospital of Shanxi Medical University were compared and analyzed.According to the different operation methods, those patients were divided into Group A with 18 cases and Group B with 28 cases.Group A was treated with the emergency operation within 6 hours of injury and the operation method was the limited open reduction and internal fixation combined with external fixator after thorough debridement of wound.Group B was treated with debridement and suture, detumescence, infection prevention, and calcaneal traction or plaster external fixation at first and then with ORIF on 7-15 days after the soft tissue recovered well, and the operation method involves the fibula fixation with 1/3 tubular plate after reduction and the distal tibia and lower tibiofibular syndesmosis fixation after reduction and bone grafting.The two groups were compared in the quality of fracture reduction, incidence of wound complications, fracture healing time and Bourne standard ankle function score.Results Group B was significantly better than Group A in the Burwell-Charnley score, fracture malunion and incidence of wound complications, and there were no significant differences in the fracture healing time and Bourne ankle function score between the two groups.Conclusion For open AO-C3 Pilon fracture, the emergency operation within 6 hours after injury and the second-stage operation after debridement are the better treatment methods.However, the second-stage operation after debridement can reduce the risks of operation and hospitalization by improving the anatomical reduction rate of fracture and lowering the incidence of wound complications.