摘要
目的:对比分期切开复位内固定(open reduction and internal fixation,ORIF)与外固定架结合有限内固定(external fixation combined with limited internal fixation,EFLIF)治疗高能量胫骨Pilon骨折的临床效果及对并发症的影响。方法:回顾性分析2021年1月至2023年10月就诊的78例高能量胫骨Pilon骨折患者,根据治疗方案分为分期ORIF组和EFLIF组。分期ORIF组48例,男29例,女19例;年龄33~53(43.25±4.67)岁;受伤至就诊时间(6.54±2.21)h;接受分期ORIF治疗。EFLIF组30例,男18例,女12例;年龄36~54(43.37±3.24)岁;受伤至就诊时间(6.87±1.96)h;接受EFLIF治疗。观察并比较两组患者术后6个月踝关节功能恢复、骨折复位情况、骨折愈合时间及手术相关指标。记录两组术后并发症。结果:两组患者均获随访,时间6~12(8.97±1.26)个月。术后6个月分期ORIF组美国足踝外科协会评分(American Orthopedic Foot and Ankle Society,AOFAS)评分(83.15±20.93)分,与EFLIF组(81.88±20.67)分比较,差异无统计学意义(P>0.05)。分期ORIF组骨折复位优良率33.33%(16/48),与EFLIF组30.00%(9/30)比较,差异无统计学意义(P>0.05)。分期ORIF组住院时间及骨折愈合时间分别为(16.57±1.25)d、(12.14±1.15)周,与EFLIF组的(15.97±2.16)d、(12.36±1.17)周比较,差异均无统计学意义(P>0.05)。分期ORIF组术中出血量(76.54±11.65)ml,多于EFLIF组的(70.15±10.29)ml,差异有统计学意义(P<0.05);浅表组织感染发生率2.08%(1/48),低于EFLIF组的16.67%(5/30),差异有统计学意义(P<0.05)。结论:分期ORIF和EFLIF均可有效治疗高能量闭合性胫骨Pilon骨折,但在浅表组织感染发生风险控制上分期ORIF优于EFLIF。
Objective To compare the clinical efficacy and complication rates of staged open reduction internal fixation(ORIF)and external fixation combined with limited internal fixation(EFLIF)in the treatment of high-energy Pilon fractures.Methods A retrospective selection was conducted on 78 patients diagnosed with high-energy tibial Pilon fractures who received treatment between January 2021 and October 2023.These patients were categorized into the staged ORIF group and the EFLIF group according to their respective treatment protocols.The staged ORIF group comprised 48 patients,including 29 males and 19 females,aged from 33 to 53 years old with a mean age of(43.25±4.67)years old.The time from injury to treatment averaged(6.54±2.21)hours.All patients received staged ORIF treatment.The EFLIF Group consisted of 30 patients,including 18 males and 12 females,aged from 36 to 54 years old with a mean age of(43.37±3.24)years old.The time from injury to treat-ment averaged(6.87+1.96)hours.All patients received EFLIF treatment.The recovery of ankle joint function,fracture reduc-tion quality,fracture healing time,and surgical-related indicators between two groups were observed and compared six months after surgery.Additionally,the postoperative complications of the two groups were recorded.Results Both groups of patients were followed up and the duration ranged from 6 to 12 months,with an average of(8.97±1.26)months.At 6-month postopera-tive fllow-up,the American Orthopaedic Foot and Ankle Society(AOFAS)score in the ORIF group was(83.15+20.93),which did not show a statistically significant difference compared to the EFLIF group(81.88±20.67),P>0.05.The excellent and good rate of fracture reduction in the staged ORIF group was 33.33%(16/48),which did not show a statistically signifi-cant difference compared to the EFLIF group(30.00%,9/30),P>0.05.The hospitalization duration and fracture healing time in the staged ORIF group were(16.57+1.25)days and(12.14±1.15)weeks,respectively.When compared to the EFLIF group,which demonstrated a hospitalization duration of(15.97±2.16)days and a fracture healing time of(12.36±1.17)weeks,no statistically significant dfferences were observed(P>0.05).The intraoperative blood loss in the staged ORIF group was(76.54±11.65)ml,which was significantly higher than that in the EFLIF group(70.15±10.29)ml,and the difference was statistically significant(P<0.05).The incidence of superficial tissue infection was 2.08%(1/48),which was significantly lower than that observed in the EFLIF group at 16.67%(5/30),and this difference was statistically significant(P<0.05).Conclu-sion Both staged ORIF and EFLIF were effective treatment options for high-energy closed Pilon fractures of the tibia.Howev-er,regarding the prevention of superficial tissue infection,staged ORIF demonstrates superior risk control compared to EFLIF.
作者
陈伟清
陈叶海
舒军荣
徐宝平
陈保林
杨俊涛
胡秀坡
CHEN Wei-qing;CHEN Ye-hai;SHU Jun-rong;XU Bao-ping;CHEN Bao-lin;YANG Jun-tao;HU Xiu-po(Department of Orthopaedics,Dongyang Huayuantian Hospital,Dongyang 322121,Zhejiang,China)
出处
《中国骨伤》
2025年第7期716-721,共6页
China Journal of Orthopaedics and Traumatology
关键词
高能量骨折
胫骨PILON骨折
外固定架
有限内固定
并发症
High-energy fracture
Tibial Pilon fracture
External fixator
Limited internal fixation
Complication
