ABSTRACT
Objective:To investigate the clinical efficacy of early versus delayed open reduction and internal fixation in the treatment of tibial pilon fracture. Methods:Sixty patients with tibial pilon fractures admitted to Zhejiang Veteran Hospital from May 2018 to May 2021 were included in this study. They were randomly divided into a control group and a study group ( n = 30/group) using the coin-tossing method. Patients in the control group underwent early reduction and internal fixation within 3 days after injury. Patients in the study group underwent delayed reduction and internal fixation during 7-14 days after injury. The time to bone fracture healing and the time to independent weight-bearing walking were recorded. At 3 and 6 months after surgery, the American Orthopedic Foot and Ankle Society score, Visual Analogue Scale score, clinical efficacy, and incidence of complications were compared between the two groups. Results:The time to bone fracture healing and the time to independent weight-bearing walking in the study group were (8.23 ± 0.63) weeks and (11.77 ± 0.82) weeks, respectively, which were significantly shorter than (9.57 ± 0.86) weeks and (13.40 ± 0.93) weeks in the control group ( t = 6.87, 7.21, both P < 0.001). At 3 months after surgery, American Orthopedic Foot and Ankle Society score in the study group was significantly higher than that in the control group, and the Visual Analogue Scale score in the study group was significantly lower than that in the control group ( t = 6.69, 5.16, both P < 0.001). Overall excellent and good rate of clinical efficacy in the study group was significantly higher than that in the control group (86.6% vs. 63.3%, χ2 = 4.35, P = 0.037). At 6 months after surgery, there were no significant differences in American Orthopedic Foot and Ankle Society score and Visual Analogue Scale score between the two groups ( t = 0.96, 1.12, P = 0.339, 0.267). At 6 months after surgery, there was no significant difference in the overall excellent and good rate of clinical efficacy between the study and control groups (96.6% vs. 90.0%, χ2 = 0.26, P = 0.605). The incidence of complications in the study group was significantly lower than that in the control group (3.3% vs. 26.6%, χ2 = 4.70, P = 0.030). Conclusion:Delayed open reduction and internal fixation after reducing injury to the soft tissue of the affected limbs can effectively shorten the rehabilitation cycle of tibial pilon fracture, increase short-term efficacy, and decrease the risk of postoperative complications.
ABSTRACT
Objective:To investigate the clinical effects of vacuum sealing drainage (VSD) negative pressure suction combined with Masquelet technique in the treatment of open comminuted fractures of limbs.Methods:120 patients with open comminuted fractures of limbs who received treatment in Rongjun Hospital of Zhejiang Province from June 2017 to June 2020 were included in this study. All of them underwent treatment by VSD negative pressure suction combined with Masquelet technique. The changes in rehabilitation indices, inflammatory factors and quality of life relative to before surgery and Visual Analogue Scale score before and 1 and 3 months after surgery were determined.Results:All 120 patients were included in the final analysis. Granulation tissue growth time was (10.53 ± 2.39) days. Infection control time was (14.32 ± 3.24) days. Wound closure time was (10.87 ± 2.84) days. Fracture healing time was (9.57 ± 1.84) weeks. The VAS score at 1 and 3 months after surgery was (3.21 ± 1.58) points and (1.45 ± 0.76) points, respectively, which was significantly decreased compared with before surgery [(8.23 ± 1.52) points, t = 25.082, 43.704, both P < 0.05]. The VAS score at 3 months after surgery was lower than that at 1 month after surgery ( t = 10.996, P < 0.05). Serum tumor necrosis factor-α, C-reactive protein and interleukin-6 levels at 1 and 3 months after surgery were significantly decreased compared with before surgery ( t = 14.798, 29.598, 30.599, 47.970, 17.161, 31.587, all P < 0.05). Serum tumor necrosis factor-α, C-reactive protein and interleukin-6 levels at 3 months after surgery were significantly lower than those at 1 month after surgery ( t = 14.401, 21.218, 17.513, all P < 0.05). The World Health Organization Quality of Life-BREF score at 1 and 3 months after surgery were significantly increased compared with before surgery ( t = 17.803, 36.482, both P < 0.05). The World Health Organization Quality of Life-BREF score at 3 months after surgery was significantly higher than that at 1 month after surgery ( t = 10.488, P < 0.05). Conclusion:VSD negative pressure suction combined with Masquelet technique for the treatment of open comminuted fractures of limbs exhibits good efficacy, can alleviate pain, reduce inflammatory reactions, improve quality of life, and thereby is of important clinical value.