双反牵引在Pilon骨折围手术期的应用研究

Perioperative application of double reverse traction in the treatment of Pilon fracture

目的探讨双反牵引在Pilon骨折围手术期的应用研究。方法回顾性分析2016年1月~2019年12月收治的严重Pilon骨折患者29例,包括男性25例,女性4例;年龄20~54岁,平均38.4岁。骨折按AO/OTA分型均为43C3。入院后给予牵引,二期行内固定手术。所有患者分2组,跟骨牵引组(15例)行跟骨牵引,牵引重量为体重的1/8。双反牵引组(14例)行双反牵引,牵引过程中给予调节牵引长度及角度。比较2组Pilon骨折的牵引后消肿时间以及跟骨牵引后24 h、3 d、7 d的VAS评分,牵引后即刻和牵引7天后骨折断端重叠程度及内外侧成角程度改善情况。结果牵引后至软组织消肿时间:跟骨牵引组11.20±2.426 d,双反牵引组9.07±2.303 d。牵引后24 h、3 d、7 d的VAS评分:跟骨牵引组分别为6.00±1.069、3.40±0.986、2.80±0.676,双反牵引组分别为4.36±1.008、2.71±0.611、1.57±0.756,双反牵引组明显优于跟骨牵引组,且随着牵引的时间延长效果越明显,差异有统计学意义(P<0.05)。牵引后即刻跟骨牵引组骨折断端重叠长度为1.94±0.415 cm,双反牵引组为1.84±0.401 cm;牵引7天后跟骨牵引组重叠长度为1.54±0.35 cm,双反牵引组为1.25±0.308 cm。牵引后即刻跟骨牵引组骨折断端成角角度为19.80±6.753°,双反牵引组为18.57±5.388°;牵引7天后跟骨牵引组成角角度为15.13±4.155°,双反牵引组为10.64±3.478°。两种方法改善Pilon骨折后断端重叠长度和成角的差异具有统计学意义。结论Pilon骨折围手术期采用骨牵引作为临时固定,稳定可调的双反牵引能加快患肢消肿,减轻疼痛,改善患肢力线长度,为简化手术做准备。

Objective To investigate the application of double reverse traction in the perioperative period of Pilon fracture.Methods Twenty⁃nine cases of severe Pilon fractures from January 2016 to December 2019 were retrospectively analyzed,which including 25 males and 4 females,with an average age of 38.4 years(range,20~54 years).According to AO/OTA classification,all fractures were 43C3.Traction was given after admission,and internal fixation was performed in the second stage.In the calcaneal traction group(n=15),the traction weight was 1/8 of the body weight.In the double reverse traction group(n=14),the traction length and angle were adjusted.The detumescence time of Pilon fracture after traction,VAS score of 24 h,3 d and 7 d after calcaneal traction,the degree of overlap of fracture site and the improvement of internal and external angulation were compared between the two groups.Results The time from traction to soft tissue detumescence was(11.20±2.426)d in calcaneal traction group and(9.07±2.303)d in double reverse traction group.The VAS scores of 24 h,3 d and 7 d after traction were(6.00±1.069),(3.40±0.986)and(2.80±0.676)respectively in calcaneal traction group,(4.36±1.008),(2.71±0.611)and(1.57±0.756)respectively in the double reverse traction group,and the double reverse traction group was significantly better than the calcaneal traction group(P<0.05).The overlapping length of fracture site at 0 hour after traction was(1.94±0.415)cm in the calcaneal traction group,(1.84±0.401)cm in the double reverse traction group;this at 7 days were(1.54±0.350)cm in calcaneal traction group and(1.25±0.308)cm in double reverse traction group,P<0.05 when compared between two groups.The angle of fracture site in the calcaneal traction group before traction was(19.80±6.753)°,(18.57±5.388)°in the double reverse traction group;this at 7 days was(15.13±4.155)°in the calcaneal traction group and(10.64±3.478)°in the double reverse traction group,and the difference was statistically significant.Conclusion Using bone traction as temporary fixation in perioperative period of Pilon fracture,stable and adjustable double reverse traction can accelerate the relief of swelling,relieve pain,improve the length of force line of affected limb,and make preparation for simplifying operation.