分期治疗65岁以上老年Gustilo Ⅲ A型Pilon骨折效果分析

Analysis of the Curative Effect of the Treatment of Gustilo Ⅲ A Pilon Fracture in the Elderly Over 65 Years Old by Stages

目的:探讨分期治疗联合营养支持治疗65岁以上Gustilo Ⅲ A型开放Pilon骨折的方法和效果.方法:回顾性分析2015年12月—2021年12月于我院采用外固定架与内固定分期治疗联合营养支持治疗的36例65岁以上Gustilo Ⅲ A型开放Pilon骨折患者的临床资料.结果:共计36例患者获得随访,平均随访(16.3±5.2)个月.骨折临床愈合时间平均为9.3个月.末次随访时,骨折愈合优良率为80.56%.4例术后出现骨折端无骨痂生长,其中2例于内固定术后6个月行植骨治疗后愈合,1例患者伤口皮肤坏死,拆除内固定、VSD负压吸引换药后瘢痕愈合.结论:对于65岁以上Gustilo Ⅲ A型Pilon开放骨折外固定架联合内固定分期治疗能在早期提供良好的稳定性,改善患者临床症状,有利于伤口的治疗,降低骨不愈合、骨髓炎等并发症的发生率.

Objective:To investigate the method and effect of staging therapy combined with nutritional support for Gustilo ⅢA open Pilon fracture over 65 years old.Methods:The clinical data of 36 patients over 65 years old with Gustilo ⅢA type open Pilon fracture who received staging treatment with external fixation and internal fixation combined with nutritional support in our hospital from December 2015 to December 2021 were retrospectively analyzed.Results:A total of 36 patients were followed up for(16.3±5.2)months on average.The average clinical healing time of fractures was 9.3 months.At the last follow-up,the rate of fracture healing was 80.56%.There was no callus growth at the fracture end of 4 patients after surgery,2 of them healed after bone grafting 6 months after internal fixation,and 1 patient had wound skin necrosis and scar healing after removal of internal fixation and VSD suction dressing change.Conclusion:Staging treatment with external fixation combined with internal fixation for Gustilo ⅢA Pilon open fracture over 65 years old can provide good stability in the early stage,improve the clinical symptoms of patients,facilitate the treatment of wounds,and reduce the incidence of bone nonunion,osteomyelitis and other complications.