| Objective:With the growing world population and the continuing development of China’s economy, improve the people’s living level constantly, the demand of housing construction and transportation vehicles to use the prevalence, makes the tibial Pilon fracture incidence was gradually increasing attitude.Due to its special occurrence site,on the fracture classification, timing of surgery and treatment has not a fixed, uniform standard to follow, resulting in its treatment of the relative difficulty in clinical practice.This article selects two kinds of operation method is used clinically for the treatment of tibial Pilon fracture, on early open reduction and internal fixation and open reduction and internal fixation operation step by step delay treatment of tibial Pilon fracture were analysed in the paper, the clinical effect, to provide reliable basis for the medical workers in the treatment of patients with a more efficient method of tibial Pilon fracture.Data and Methods:A retrospective analysis of the Second Hospital of Dalian Medical University during the period from March 2013 to March 2015 admitted to the department of orthopedics, selected 66 cases of tibial Pilon fracture patients, 33 patients will be implemented early open reduction and internal fixation of the defined as the observation group, 33 patients with multi-step delay definition open reduction andinternal fixation for the control group.In theobservation group,there are24 males and 9 females, aged 18-61 years, mean age 39.2 ± 11.7 years; traffic accident in 10 cases, 14 cases of fall injury, falls 9 cases; 7 cases of open injury,26 cases of closed injury;Fracture Classifications in Clinical Practice: Rüedi-Allg?wer II in 15 cases,Rüedi-Allg?wer III in 18 cases。In thecontrol group,there are26 males and 7 females,aged 19-63 years, mean age 40.2 ± 13.2 years; traffic accident in 11 cases, 16 cases of fall injury, falls 6 cases; 8 cases of open injury,25 cases of closed injury;Fracture Classifications in Clinical Practice: Rüedi-Allg?wer II in 11 cases, Rüedi-Allg?wer III in 22 cases。We make a comparison for the two groups of patients in general condition,Intraoperative blood loss,operation time, the effect of treatment,fracture healing time, postoperative complications and ankle function score to carry on the analysis comparison.Results:All patients were followed-up for postoperation,follow-up time is 6 month to24 month, We do an analysis of general information about Sex, age, mechanism of injury,andy fracture classifications,Differences between the two groups in the statistical analyzes were no significance(P> 0.05); The operation time of thecontrol group was about 65.8±8.5 min, intraoperative blood loss was about 38.3±8.5 ml, fracture healing time was about 13.7±2.0 weeks; The operation time of theobservation group was about93.9±17.0 min, intraoperative blood loss was about 82.8±13.7 ml, fracture healing time was about 15.2±1.8 weeks,The control group was significantly lower than in the observation group, Differences between the two groups in the statistical analyzes were significance(P<0.05); The postoperative complications in the Control group was lower than in the observation group; According to the”Mazur ankle evaluation grading system” after operation,we found that, the excellent and good rate in the observation group was 72.7%,the control group was 84.8%,the control group was higher than in the observation group. Differences between the two groups in the statistical analyzes were significance(P<0.05).Conclusion:Two kinds of operation methods have their respective characteristics on the treatment of tibia pilon fracture,all can fixed the fracture site firmly, keep the smooth articular surface of the entire complex,maintain tibia biomechanical line, prevention and treatment of complications of effective, to provide the conditions for the patients with early rehabilitation exercise.But comparatively speaking, multi-step delayed open reduction and internal fixationoperation can shorten the operation time,reduced the amount of bleeding,especially for patients with comprehensive disease reduces the riskof intraoperative.The main thing is that it is more effective to reduce the probability of occurrence of soft tissue complications by the “lag” of the soft tissue., thereby reducing the nonunion, then the probability of the occurrence of late complications such as osteomyelitis.Thereby reducing the chance of late complications happen again,such as Nonunion,osteomyelitis and so on. Create favorable conditions for the resumption of fracture healing in patients with good and early joint function. |
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