交锁髓内钉与外支架治疗严重胫骨开放性骨折的疗效分析  

Analysis of the effect on severe open tibial fracture treated with locked intramedullary nailing and external fixation

作　　者：晋大祥[1] 梁德[1] 杨达文[1] 

机构地区：[1]广州中医药大学第一附属医院骨二科,广东广州510405

出　　处：《中国骨伤》2006年第8期478-480,共3页China Journal of Orthopaedics and Traumatology

基　　金：广东省科技计划项目(编号:2005B33001031)

摘　　要：目的：评价交锁髓内钉与外支架治疗严重胫骨开放性骨折的临床疗效。方法：严重胫骨开放性骨折患者39例，采用单侧外固定支架固定19例，男13例，女6例；年龄19～72岁，平均39岁；稳定性骨折7例，不稳定性骨折12例；合并其他部位骨折7例，颅脑损伤1例，腹部损伤2例。采用交锁髓内钉固定20例，男14例，女6例；年龄22～70岁，平均42岁；稳定性骨折8例，不稳定性骨折12例；合并其他部位骨折8例，颅脑伤2例，腹部伤1例。两组最初的伤口清创、软组织缺损的皮瓣移植修复是相同的。结果：随访时间平均为20个月（18—35个月），交锁髓内钉组骨折愈合时间（6．0±2．6）个月，外支架组骨折愈合时间为（7．0±2．5）个月。交锁髓内钉组膝关节的活动范围为115°±10°，踝关节为30°±5°，外支架组膝关节的活动范围为110°±5°，踝关节为27°±4°，髓内钉组功能恢复较好，成角畸形小。外支架组1例深部感染，4例钉道感染，髓内钉组1例深部感染。按功能评定标准，髓内钉组中优8例，良7例，中2例，差3例；外支架组中优4例，良5例，中3例，差7例。两组差异具有统计学意义（P〈0．05）。比较骨折愈合时间、部分负重时间、踝膝关节的活动范围，两组之间无显著性差异。结论：在彻底清创，并且具备即刻或早期皮瓣修复的技术条件下，交锁髓内钉是治疗严重胫骨开放性骨折的理想选择。Objective：To analyse the effect of interlocking intramedullary nailing and external fixation for treatment of severe open tibial fractures. Methods：Thirty-nine patients with severe open tibial fracture were divided into two groups according to the fixation. Of 39 patients, 19 （13 male and 6 female; the average age of 39 years ranging from 19 to 72 years） were treated by interlocking intramedullary nailing. There were 7 cases of stable fracture and 12 of unstable fracture, complicating other fracture in 7 cases,craniocerebral injuries in 1 case,abdominal injuries in 2 cases;20 （ 14 male and 6 female;the average age of 42 years ranging from 22 to 70 years） were treated by external fixation. There were 8 cases of stable fracture and 12 of unstable fracture, complicating other fracture in 8 cases, craniocerebral injuries in 2 cases, abdominal injuries in 1 ease. Both groups had the same initial debridment and coverage of the soft-tissue defect with pedicled flaps. Results：The mean follow-up period was 20 months. In the interlocking intramedullary nail group, the time to fracture healing was （6. 0 ±2. 6） months,and the range of motion respectively was 115° ＋ 10°in the knee and 30° ＋5° in the ankle at the final follow-up. In the external fixation group, the time to fracture healing was （7.0 ± 2. 5 ） months, and the range of motion was respectively 110° ±5° in the knee and 27°±4° in the ankle at the final follow-up. The interlocking intramedullary nail group had slightly better motion and less final angulation. Complications included one deep infection and four pin-track infections in external fixation group and one deep infection in the external fixation group. According the function standard, in interlocking intramedullary nail group the result were excellent in 8 cases, good in 7 cases, fair in 2 cases, poor in 3 cases ; in external fixation group the result were excellent in 4 cases, good in 5 cases, fair in 3 cases, poor in 7 cases. There were significant statistical difference

关 键 词：胫骨骨折 外固定器 骨折固定术 髓内 

分 类 号：R683.420.5[医药卫生—骨科学]