交锁髓内钉治疗开放性胫腓骨骨折的并发症及防治  

Prevention of Complications of the Open Tibial Fractures Treated with Interlocking Intram-edullary Nail

作　　者：董金波[1] 王维山[1] 史晨辉[1] 王永明[1] 刘维钢[1] 李宽新[1] 朱卫国[1] 

机构地区：[1]石河子大学医学院第一附属医院骨一科,832008

出　　处：《农垦医学》2003年第6期396-399,共4页Journal of Nongken Medicine

摘　　要：目的 :观察交锁髓内钉治疗开放性胫腓骨骨折的并发症及防治。方法 :1 999年 1月～ 2 0 0 2年 1 2月用交锁髓内钉治疗开放性胫腓骨骨折 4 1例。男 31例 ,女 1 0例 ;Ⅰ型 1 5例 ,Ⅱ型 2 5例 ,Ⅲa型 1例 ;左侧 1 3例 ,右侧 2 8例 ;年龄 2 4～ 6 6岁 ,平均 4 0 .2岁 ;Ⅰ型 1 5例均采用扩髓及静力型固定 ,Ⅱ型 2 5例及Ⅲa型 1例均未扩髓。结果 :4 1例均得到随访 ,平均 1 8个月 (2个月～ 3年 )。愈合时间为 1 2～ 5 2周 ,平均 2 6 .4周。其中感染 4例 ,主钉断裂 1例 ,锁钉断裂 4例 ,成角畸形 1例 ,锁钉误穿 4例 ,大隐静脉损伤 2例 ,骨折延迟愈合 2例。结论 :交锁髓内钉治疗胫腓骨开放性骨折存在一定的并发症 ,在临床使用中必须引起高度重视 ;Objective:To observe complications of tibial shaft fractures with interlocking intramedullary nail.Methods:41 cases of tibial shaft fractures were treated with interlocking intramedullary nail from January 1999 to December 2000. There are 31 males and 10 females.13 fractures were of left tibia and 28 of right; Classified by Gustilo: 15 cases are type Ⅰ,25 cases are type Ⅱ,1 case is type Ⅲa.The average age was 40.2 years (ranged 24～66 years); The cases of type Ⅰ were treated with reamed nails and static interlocking. The cases of type Ⅱ and type Ⅲa were treated with non- reamed nails.Results:41 cases were followed up for an average of 18months(ranged 2 month～3 years),The time to fracture union average 26.4 weeks(ranged 12～52 weeks).The complications included infection in 4 cases,nail broken in 1, screw broken in 4,angular malunion in 1,failure interlock in 4,great saphenous vein injured in 2,delayed union in 2.Conclusion:Interlocking intramedullary nail is a good internal fixation for tibial fractures,but should prevent complications.The open fractures should use non-reamed interlocking intramedllary nail.

关 键 词：治疗 并发症 交锁髓内钉 开放性胫腓骨骨折 扩髓 愈合时间 成角畸形 防治 高度 年龄 

分 类 号：R683[医药卫生—骨科学] R735.7[医药卫生—外科学]