单侧外固定治疗重度Pilon骨折的临床疗效探究

Clinical effect of unilateral external fixation in the treatment of severe Pilon fracture

目的探讨单侧外固定治疗重度Pilon骨折的临床疗效。方法回顾性分析2017年6月-2018年12月南京中大医院江北院区骨科收治的重度Pilon骨折患者100例,男性54例,女性46例;年龄18~65岁,平均35.5岁;Ruedi-AllgowerⅡ型39例,Ⅲ型61例。按照不同固定方法分为常规固定组和单侧外固定组,各50例,比较两组患者住院时间、完全负重下地时间、骨折愈合时间,评价治疗前及治疗后3个月踝关节活动度、踝关节功能恢复情况、疼痛程度,并统计患者的治疗效果及并发症发生情况。结果单侧外固定组住院时间、完全负重下地时间、骨折愈合时间分别为(16.50±1.50)d、(132.56±10.25)d、(14.16±0.69)周,均短于常规固定组(19.25±2.35)d、(198.65±16.58)d、(17.58±1.50)周(t/P=6.975/0.001、23.970/0.001、14.650/0.001)。治疗后3个月,单侧外固定组踝关节Mazur评分为(85.67±6.59)分,显著高于常规固定组(62.78±3.45)分,VAS评分为(2.23±0.36)分,低于常规固定组(4.59±0.89)分(t/P=21.760/0.001、17.380/0.001);单侧外固定组患者踝关节活动度分别为(17.29±0.16)°、(28.36±1.23)°、(19.68±0.16)°、(16.89±2.12)°,均高于常规固定组(10.62±1.25)°、(21.57±2.58)°、(14.36±1.62)°、(14.25±0.57)°(t/P=37.430/0.001、16.800/0.001、23.110/0.001、8.503/0.001)。单侧外固定组治疗优良率为90.00%,显著高于常规固定组74.00%(χ^2/P=4.336/0.037)。单侧外固定组总并发症发生率为4.00%,显著低于常规固定组的18.00%(χ^2/P=5.005/0.025)。结论单侧外固定支架治疗重度Pilon骨折可有效减轻患者疼痛症状,提高患者踝关节活动度,恢复患者功能,治疗效果显著,安全性较高。

Objective To investigate the clinical effect of unilateral external fixation in the treatment of severe Pilon fracture.Methods Totally 100 patients with severe pilon fracture were admitted into our hospital from Jun.2017 to Dec.2018.There were 54 males and 46 females,with an average age of 35.5 years(18-65 years).There were 39 cases of Rudi-Allgower typeⅡ,and 61 cases of typeⅢ.Patients were divided into conventional fixation group(50 cases)and unilateral external fixation group(50 cases).The length of stay,time of fully loaded landing,and fracture healing time were recorded,and ankle mobility,ankle function recovery,degree of pain,and the therapeutic effect and complications were evaluated at 3 months before and after treatment.Results The length of stay,time of fully loaded landing,fracture healing time in the unilateral external fixation group were(16.50±1.50)days,(132.56±10.25)days,(14.16±0.69)weeks,respectively,which were shorter than those in the conventional fixation group(19.25±2.35)days,(198.65±16.58)days,(17.58±1.50)weeks(t/P=6.975/0.001,23.970/0.001,14.650/0.001).At 3 months after treatment,Mazur’s ankle joint scoring in the unilateral external fixation group was(85.67±6.59)points,higher than conventional fixation group of(62.78±3.45)points;the VAS score in the unilateral external fixation group was(2.23±0.36)points,lower than that in the conventional fixation group of(4.59±0.89)points(t/P=21.760/0.001,17.380/0.001);ankle joint mobility in the unilateral external fixation group was(17.29±0.16)°,(28.36±1.23)°,(19.68±0.16)°and(16.89±2.12)°,which were higher than those of the conventional fixation group(10.62±1.25)°,(21.57±2.58)°,(14.36±1.62)°and(14.25±0.57)°(t/P=37.430/0.001,16.800/0.001,23.110/0.001,8.503/0.001).The excellent and good rate of the treatment in the unilateral external fixation group was 90.00%,higher than the conventional fixation group of 74.00%(χ^2/P=4.336/0.037).The total complication rate in the unilateral external fixation group was 4.00%,lower than the conventional fixation group of 18.00%(χ^2/P=5.005/0.025).Conclusion Unilateral external fixator can effectively reduce the pain symptoms,improve the ankle joint activity and recover the function of patients with severe Pilon fracture.It has significant therapeutic effect and high safety.