| Objective To evaluate the efficacy of delayed open reduction and internal fixation operation in the treatment of tibial pilon fracture,and to statistically analyze the related factors that may affect the surgical efficacy,in order to provide a clinical basis for improving the prognosis of patients with tibial pilon fracture.Methods A total of 63 patients with closed tibial pilon fracture were selected from December 1,2020 to August 1,2022 in the Department of Traumatology,General Hospital of Ningxia Medical University treated by delayed open reduction and internal fixation operation.Among them,10 patients were lost to follow-up or incomplete follow-up,and 53 patients were finally included in this study.All enrolled patients were followed up after surgery,and Mazur score was used as the function evaluation standard.The follow-up time was 6-26 months,with an average of(15.1±5.2)months.Mazur score of all patients was 51-98 points,with an average of(86.13±11.08)points.According to the score results,the enrolled patients were divided into Mazur score excellent group and Mazur score poor group.General data(age,sex,preoperative waiting time)and clinical data of the two groups were analyzed(diabetes mellitus,smoking status,education background,work-related injury,cause of injury,combined with other injuries),fracture related data(combined with fibula fracture,Rüedi-Allg?wer fracture classification,fracture reduction quality,postoperative functional exercise timing)on the effect of postoperative efficacy were statistically analyzed.Results Univariate analysis showed that there were 20 cases(14 males and 6 females)with excellent Mazur score.The average age was(38.55±10.62)years.There were 33 cases(25males and 8 females)in the group with non-excellent clinical efficacy.The age ranged from 22to 66 years old,with a mean of(45.52±11.74)years old.There were no significant differences between the two groups in gender(P=0.645),preoperative waiting time(P=0.187),diabetes mellitus(P=0.871),smoking(P=0.450),educational background(P=0.198),work-related injury(P=0.950),cause of injury(P=0.987),and injury of other parts(P=0.551).There were significant differences in age(P=0.035),fibula fracture(P=0.005),Rüedi-Allg?wer fracture classification(P=0.043),fracture reduction quality(P=0.003),and postoperative functional exercise timing(P=0.002).?~2 segmentation method is used to fracture classification,the quality of the fracture,postoperative function exercise the pairwise comparison between the experimental group found that Rüedi-Allg?wer I type and type II group(P=0.123),Rüedi-Allg?wer II group and III group(P=0.094),normal reduction group and poor reduction group(P=0.299),1-week-1 month group and>1 month group(P=0.299)had no statistical significance on postoperative efficacy.Rüedi-Allg?wer I group and III group(P=0.004),anatomic reduction group and normal reduction group(P=0.010),anatomic reduction group and poor reduction group(P=0.004),<1 week group and 1 week-1 month group(P=0.005),<1 week group and>1 month group(P=0.004)had a statistically significant effect on postoperative efficacy.Binary Logistic regression analysis was performed on 5 variables with statistical significance in the univariate analysis,and the results showed that the quality of fracture reduction and the timing of postoperative functional exercise were independent factors affecting the postoperative efficacy of patients.Conclusion Delayed open reduction and internal fixation operation for pilon fractures has a better overall prognosis and fewer postoperative complications.The quality of fracture reduction and the timing of postoperative functional exercise were the independent factors influencing the clinical effect of delayed open reduction and internal fixation operation on pilon fracture.Age,gender,preoperative waiting time,diabetes mellitus,smoking status,educational background,work-related injury and cause of injury are not independent influencing factors. |
PDF Full Text Request