单纯内固定与有限内固定结合外固定在治疗高能量闭合性pilon骨折中的比较  

Comparision between simple internal fixtion and limited internal fixtion combined with external fixtion for treatment of high-energy closed pilon fracture

作　　者：侯念宗[1] 陈皓[1] 刘文宙[1] 陈炳豪[1] Aditya 宋卫东[1] 

机构地区：[1]中山大学孙逸仙纪念医院骨外科,广州510120

出　　处：《岭南现代临床外科》2013年第2期113-116,共4页Lingnan Modern Clinics in Surgery

基　　金：广东省科技计划项目(2011B031800217)

摘　　要：目的比较单纯内固定与有限内固定结合外固定在治疗高能量闭合性pilon骨折中的临床效果,评估两种术式在治疗高能量闭合性Pilon骨折中的优劣。方法回顾性分析2001年12月至2010年12月收治的42例高能量闭合性Pilon骨折的临床资料。按手术方式不同分为两组:A组26例,行切开复位单纯内固定手术(ORIF);B组16例,行切开复位有限内固定结合外固定手术(LORIF+EX)。分析术后两组患者感染、骨延迟愈合或不愈合、创伤性关节炎、关节僵硬等并发症的发生率,测量术后8个月患者关节活动度并根据AOFAS评分标准评价其踝足功能。结果术前两组患者在性别、年龄、骨折分型、受伤至手术时间等方面无明显差异(P>0.05),术后随访8～109月个月,平均37.6个月,两种治疗方法在术后并发症发生率、关节活动度及AOFAS评分并无明显差别(P>0.05)。结论对于高能量闭合性pilon骨折的治疗,切开复位内固定和切开复位有限内固定结合外固定临床疗效相当,并发症的发生率无明显差别,均可作为其治疗手段。Objective To compare the clinical outcomes of high-energy closed pilon fracture treated with simple internal fixtion and limited internal fixtion combined with external fixtion. Methods From Dec. 2001 to Dec. 2010,the clinical data of 42 cases with high-energy closed pilon fracture were analyzed retrospectively. According to the surgical methods, these patients were divided into two groups. Group A were treated by open reduction and simple internal fixtion （ORIF） in 26 cases, and Group B were treated by open reduction and limited internal fixtion combined external fixtion （LORIF plus EX） in 16 cases. The incidence of post-operative complications were statistically analyzed, including infection, bone delayed union, traumatic arthritis, ankylosis and the range of ankle activity and the function were measured according to AOFAS hindfoot score system 8 months after operation. Results No significant difference were found between two groups in gender, age, fracture type, time from injury to surgery （/9〉0.05）. The patients were followed up for 8-109 months, average 37.6 months. The differences of the two methods were no differences in the incidence rate of postoperative complications and the articular activity and AOFAS scores of ankle. Conclusions For the treatment of high-energy closed Pilon fracture, the curative effects of ORIF and ORIF plus EX were similar and postoperative complications were no diffferences. But for the pilon fracture associated with severe soft tissue injury, ORIF plus EX is a better choice.

关 键 词：PILON骨折 内固定 外固定 疗效 

分 类 号：R683.41[医药卫生—骨科学]