目的 :比较分析三种不同手术方式治疗 Ⅱ、Ⅲ 型高能量胫骨pilon骨折的近远期疗效.方法 :以我院2010年3月~2014年3月收治的103例 Ⅱ、Ⅲ 型高能量胫骨pilon骨折患者为研究对象,根据不同术式将其分为一组(一期切开复位内固定)、二组(有限内固定+外固定)与三组(分步延期手术),术后随访12~30个月,平均18个月,比较各组近远期疗效.结果 :三组手术时间、术中出血量、骨折愈合时间、术后并发症总发生率均显著少于一组、二组;三组末次随访踝关节功能恢复优良率、总体健康、疼痛、活力、躯体功能及躯体角色评分均显著高于二组;一组末次随访踝关节功能恢复优良率、总体健康、疼痛、活力、躯体功能评分均显著高于二组.结论 :相比一期切开复位内固定、有限内固定+外固定,分步延期手术效果最佳,能显著降低并发症发生率,促进踝关节功能恢复,改善患者生活质量,可作为Ⅱ、Ⅲ型高能量胫骨pilon骨折治疗首选手术方案.%Objective To comparethe short-term and long-term effects of three surgical methods in treating type Ⅱ and Ⅲ high-energy tibial pilon fractures. Methods 103 patients with type Ⅱ and Ⅲ high-energy tibial pilon fractures treated in our hospital between March 2010 and March 2014 were selected as study subjects, and according to different surgical methods, they were divided into group A (one-stage open reduction and internal fixation), group B (limited internal fixation and external fixa-tion) and group C (stepwise delayed surgery). All patients were followed up for 12 ~ 30months with an average of 18 months. The short-term and long-term effects were compared between groups. Results The operation time, intraoperative blood loss, fracture healing time and incidence of postoperative complications in group C were significantly less and lower than those in group A and group B; The excellent and good rate of ankle functional recovery, scores ofoverall health, pain, vitality, physical function and physical role in group C were significantly higher than those in group B, and those in group A were significantly higher than those in group B at the end of follow-up. Conclusion Compared with one-stage open reduction and internal fixa-tion, limited internal fixation and external fixation, the effect of stepwise delayed surgery is the best which can significantly re-duce the incidence of complications, promote the recovery of ankle joint function, improve the quality of life of patients, and can be used as the preferred surgery for treating type Ⅱ and Ⅲ high-energy tibial pilon fractures.
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