| Objective: Pilon fracture is the involvement of distal tibial fracture which refers to the tibial articular surface, high energy Pilon fractures in patients with high disability rate, clinical treatment difficult, postoperative complications, is one of the difficulties of orthopedics and trauma treatment at present. Its characteristic is the distal tibial articular surface compression and collapse, highly unstable, severely soft tissue injury and fibular fractures. How to choose the appropriate mode of operation time and operation is a clinical subject worthy of study. Clinical treatment of Pilon fractures were treated with traditional open reduction and internal fixation, early operation treatment in 8 hours after the fracture. With the development and progress of medical technology, many scholars adopt two-stage delayed surgical treatment of Pilon fracture, the bone traction, traction for a period of time, the soft tissue function recovery after the surgery again. The author through the observation of the tradition of early open reduction and internal fixation with two step delayed surgery for the treatment of high energy Pilon fractures of follow-up, compared to two at the time of surgery in the treatment of Pilon fractures; bleeding; fracture healing time imaging; weight; traumatic arthritis, bone nonunion, ankle joint stiffness complications; 3 months, 6 months, 12 months Baird ankle joint scoring, for clinical rational selection of Pilon fracture surgery to provide the reference.Methods: from 2009 January-2013 year in December period, high energy Pilon fractures in the Department of orthopedics in our hospital Pilon Ruedi-Allgower: type II, type III fracture patients, a total of 58 cases. The observation group(36) step by step to postpone the operation treatment, the control group(22) received early open reduction and internal fixation. The observation group male 26 cases, female 10 cases, age 22-50 years old, average age(32.6 ± 2.69) years old; injury time 2-6h, the average time of(3.4 ± 0.67) H; cause of injury: 21 cases of traffic accident, falling injury in 15 cases; 19 cases were closed fractures, 17 cases of open fractures; Ruedi-Allgower type: 12 cases of type II, III in 24 cases. Patients in the control groupmale16 cases, 6 cases of female, age 23-51 years old, average age(34.6±2.71); the time from injury to operation was 3-6h, average(3.6± 0.28) H; cause of injury: 14 cases of traffic accident, falling injury in 8 cases; 12 cases were closed fractures, 10 cases were open fracture; Ruedi-Allgower classification: 7 cases of type II, III in 15 cases. Patients admitted to hospital after emergency, control group were treated by early open reduction and internal fixation operation. Preoperative 3D CT to inspect the situation in order to guide the operation of comminuted fracture. A fibula fracture with fibula, first after the reduction plate fixation, restoration of the fibular length, position of the talus; then the exposure of the distal tibial articular surface, reduction under direct vision, and implant fixation. During the operation were performed bone graft. Intraoperative C arm inspection, display the anatomical reduction of the fracture, internal fixation location specifications appropriate fixation. The patients in observation group were calcaneal traction, traction weight about 5-6 kg. Observation of the fracture site surrounding skin, soft tissue swelling subsided, skin condition was stable, wrinkles test positive after open reduction and internal fixation. Operation and control group. Two groups of patients were treated with limb pad, antibiotics to prevent infection, 12-24 hours after the surgery began to take the initiative to practice the limb muscles during isometric exercise. When the dressing to assist patients with limb passive functional exercise, ask the patient to the positive limb functional exercise. Based on the review of the X- ray examination results, to determine the fracture has healed gradually weight-bearing limb. Observe the amount of bleeding and operation time of two groups of patients during the operation; according to the postoperative follow-up and review X ray imaging records of patients with fracture healing time, weight-bearing time; after 3 months, 6 months and 12 months for Baird ankle joint scoring; record the two groups of patients had traumatic arthritis, bone nonunion and ankle joint stiffness and other complications. Statistical analysis was performed using SPSS 13 software. Measurement data using(x ± s) said, t value of the test; count data by chi square test. P<0.05 said the difference was statistically significant.Results: all the patients were followed up for 1-2 years after operation, no dropouts. The observation group operation time, amount of bleeding in surgery patients,fracture healing time of imaging time and weight were significantly lower than those in the lower(P < 0.05); the observation group after 3 months, 6 months, 12 months Baird ankle score were significantly higher than those of early open reduction and internal fixation of the control group(P<0.05); The overall incidence of complications in the observation group(18.89%) was significantly lower than the control group(68.18%)(P < 0.05).Conclusion: This study adopts two-stage delayed operation for the treatment of high energy Pilon fractures were found, compared with the traditional treatment, two-stage delayed operation can shorten the time of operation, reduce the operation trauma, promote postoperative recovery; two-stage delayed operation can promote healing, helps to improve the early quality of life of patients with fracture; two-stage delayed operation treatment helps to reduce high energy Pilon fractures in patients with complications, to provide a strong guarantee for the recovery of ankle joint function. In a word, two step delayed operation for the treatment of high energy Pilon patients can reduce the operation trauma, promote fracture healing, reduce complications and improve the function of ankle joint fracture. |
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