早期与延期切开复位内固定术治疗胫骨Pilon骨折的临床效果比较

Clinical efficacy of early versus delayed open reduction and internal fixation in the treatment of tibial pilon fracture

目的比较早期与延期切开复位内固定术治疗胫骨Pilon骨折的临床疗效。方法选择浙江省荣军医院骨科2018年5月至2021年5月收治的创伤性胫骨Pilon骨折患者60例为研究对象,按掷硬币法分为对照组(30例)和研究组(30例)。对照组患者于创伤后3 d内行早期切开复位内固定术,研究组患者于创伤后7~14 d行延期切开复位内固定术。记录患者骨折断面骨性愈合时间和可独立负重行走时间,比较患者术后3个月、6个月踝-后足评分系统评分(AOFAS评分)、视觉模拟评分法(VAS)评分及临床疗效,观察患者术后并发症发生情况。结果研究组患者骨折断面骨性愈合时间[(8.23±0.63)周]和可独立负重行走时间[(11.77±0.82)周]均显著短于对照组[(9.57±0.86)周和(13.40±0.93)周](t=6.87、7.21,均P<0.001)。研究组患者术后3个月AOFAS评分显著高于对照组,而VAS评分显著低于对照组(t=6.69、5.16,均P<0.001);研究组临床疗效总体优良率(86.6%)显著高于对照组(63.3%)(χ^(2)=4.35,P=0.037)。两组患者术后6个月AOFAS评分和VAS评分差异均无统计学意义(t=0.96、1.12,P=0.339、0.267),临床疗效总体优良率(96.6%比90.0%)差异无统计学意义(χ^(2)=0.26,P=0.605)。研究组术后并发症总体发生率(3.3%)显著低于对照组(26.6%)(χ^(2)=4.70,P=0.030)。结论待患肢软组织创伤病情好转后行延期切开复位内固定术可有效缩短胫骨Pilon骨折康复周期,提高近期疗效,降低术后并发症风险。

Objective To investigate the clinical efficacy of early versus delayed open reduction and internal fixation in the treatment of tibial pilon fracture.Methods Sixty patients with tibial pilon fractures admitted to Zhejiang Veteran Hospital from May 2018 to May 2021 were included in this study.They were randomly divided into a control group and a study group(n=30/group)using the coin-tossing method.Patients in the control group underwent early reduction and internal fixation within 3 days after injury.Patients in the study group underwent delayed reduction and internal fixation during 7-14 days after injury.The time to bone fracture healing and the time to independent weight-bearing walking were recorded.At 3 and 6 months after surgery,the American Orthopedic Foot and Ankle Society score,Visual Analogue Scale score,clinical efficacy,and incidence of complications were compared between the two groups.Results The time to bone fracture healing and the time to independent weight-bearing walking in the study group were(8.23±0.63)weeks and(11.77±0.82)weeks,respectively,which were significantly shorter than(9.57±0.86)weeks and(13.40±0.93)weeks in the control group(t=6.87,7.21,both P<0.001).At 3 months after surgery,American Orthopedic Foot and Ankle Society score in the study group was significantly higher than that in the control group,and the Visual Analogue Scale score in the study group was significantly lower than that in the control group(t=6.69,5.16,both P<0.001).Overall excellent and good rate of clinical efficacy in the study group was significantly higher than that in the control group(86.6%vs.63.3%,χ^(2)=4.35,P=0.037).At 6 months after surgery,there were no significant differences in American Orthopedic Foot and Ankle Society score and Visual Analogue Scale score between the two groups(t=0.96,1.12,P=0.339,0.267).At 6 months after surgery,there was no significant difference in the overall excellent and good rate of clinical efficacy between the study and control groups(96.6%vs.90.0%,χ^(2)=0.26,P=0.605).The incidence of complications in the study group was significantly lower than that in the control group(3.3%vs.26.6%,χ^(2)=4.70,P=0.030).Conclusion Delayed open reduction and internal fixation after reducing injury to the soft tissue of the affected limbs can effectively shorten the rehabilitation cycle of tibial pilon fracture,increase short-term efficacy,and decrease the risk of postoperative complications.