不扩髓髓内钉与外固定支架治疗胫骨开放性骨折的比较  

Unreamed intramedullary nailing versus external fixation in the treatment of open tibial diaphyseal fracture

作　　者：汤欣[1] 孙立众[1] 刘谟震[1] 吕德成[1] 

机构地区：[1]大连医科大学第一附属医院骨科,大连116011

出　　处：《上海医学》2005年第7期552-554,共3页Shanghai Medical Journal

摘　　要：目的比较AO不扩髓胫骨髓内钉(unreamed tibial nail,UTN)与外固定支架治疗胫骨干开放性骨折的临床疗效.方法对38例胫骨干开放性骨折患者随机采用单臂半针结构外固定支架或UTN固定,随访比较其治疗结果.其中18例采用外固定治疗(外固定组),20例采用UTN治疗(UTN组).两组在性别,骨折严重程度及创伤严重度评分方面都具有可比性.结果平均随访24(12～36)个月,UTN组骨折均愈合,愈合时间平均为(30.20±4.46)周,外固定组有7例骨折不愈合,其余患者的平均愈合时间为(36.39±2.93)周,两组的差异有显著性(P=0.002).UTN组完全负重时间为术后20.2周,明显短于外固定组的36.2周(P<0.05);UTN组无深部感染,外固定组4例有明显钉道感染.结论 UTN治疗胫骨骨干开放性骨折的疗效优于外固定支架,有指征用外固定支架治疗者应适时改用UTN,以减少合并症,改善功能效果.Objective To compare the clinical outcome of the AO unreamed intramedullary nailing （UTN） with that of the external fixation in the treatment of open tibial diaphyseal fractures. Methods Thirty-eight cases of open tibial diaphyseal fractures were randomly treated with either UTN or external fixator and were followed up to compare the therapeutic results. Among them, 18 cases were treated with external fixator while the other 20 with UTN. The age, gender, fracture severity and Injury Severity Score. were worthy to be comparable in the two groups. Results A mean follow-up of 24 （ranging from 12 to 36） months revealed that the fracture united in all cases in the UTN group while there were 7 cases of nonunion in the external fixator group; with a mean healing period of 36.39±2.93 weeks for the rest （P=0. 002）. Full weight bearing began at 20.2 weeks after operation in the UTN group and at 36.2 weeks in the external fixator group. No deep infection occurred in the UTN group but there were 4 cases of significant pin track infections in the external fixator group. Conclusion In treating open tibial diaphyseal fractures, UTN is superior to the external fixator. The external fixation even when strongly indicated should be replaced by unreamed intramedullary nailing whenever it is possible, so as to reduce complications and improve the functional outcome. （Shanghai Med J, 2005, 28：552-554）.

关 键 词：胫骨 开放性骨折 外固定 不扩髓髓内钉 外固定支架治疗 胫骨开放性骨折 胫骨干开放性骨折 AO不扩髓胫骨髓内钉 平均愈合时间 创伤严重度评分 

分 类 号：R687[医药卫生—骨科学]