髓内钉治疗胫腓骨骨折适应范围及疗效探讨  

Effect on fibula-tibia fracture treatment by two different intramedullary nails

作　　者：张亚非[1] 庞桂根[1] 张涛[1] 

机构地区：[1]天津市天津医院创伤骨科,300211

出　　处：《中国矫形外科杂志》2006年第22期1693-1696,共4页Orthopedic Journal of China

摘　　要：[目的]探讨带锁髓内钉、髓内扩张自锁髓内钉的适应范围。了解上述固定物的特点以提高疗效。[方法]回顾性分析了自2000年6月～2003年9月应用带锁髓内钉、髓内扩张自锁髓内钉治疗116例胫腓骨骨折病人，其中男83例，女33例，年龄16～74岁，平均38岁。带锁髓内钉固定者60例；自锁髓内钉固定者56例。随访时间12～24个月，平均17．9个月，对于上述2种手术方法列表进行了比较。[结果]在带锁钉组优良率、愈合率、闭合复位率、扩髓率、并发症、抗旋转能力分别为89．5％、96．7％、71．6％、51．6％、21．6％和＋＋＋。髓内扩张自锁髓内钉组对应相关数据分别是91．5％，98．2％，89．3％，5．3％，3．5％和＋。[结论]带锁髓内钉是治疗胫骨骨折比较理想的内固定材料。自锁钉的手术适应症基本上同带锁钉。但自锁钉弹性固定，保持微动状态，有利于骨折早期愈合，手术更易达到微创水平。胫骨中段或中下1／3横断、斜行骨折尽量选用自锁钉。带锁钉则适宜粉碎、多段骨折。本文带锁钉扩髓与自锁钉不扩髓术式比较，两者愈合方面未显出不同。胫腓骨骨折髓内钉固定一般不必要扩髓。[ Objective ] To evaluate and compare the effects of fibial-tibial fracture （FTF） treated by interlocking intramedullary nail （II N group A） and intramedullary expand expanded self-lock nail （ IESN group B）. [ Method ] From June 2000 to September 2003,one hundred sixteen cases of FTF were treated by IIN （ N = 60） or IESN （ N = 56 ） and followed - up for 12 - 24 months （ average 17.9 months）. Results were compared between group A and group B. [ Result] In group A,the satisfactory rate, union rate, close reduction rate, medullary expanding rate, complication rate and antirotation ability were 89.5% , 96. 7%, 71.6% , 51.6% ,21.6% and ＋ ＋ ＋ respectively. In group B, that were correspondently 91.0% ,98.5 % , 89.3 % , 5.3 % , 3 % and ＋. [ConcIusion] Adopting the biological osteosynthesis either the 1 I N or IESN for treatment of FTF could get a result of more satisfactory rate and higer union rate. Applying a stable fixation,the IESN is more suitable for instable FTF. Such as multisegmental or comminuted targe oblique FTF,while of feting a flexible fixation, IESN is preferable for transverse fractures of middle and lower third tibia and fibula.

关 键 词：胫腓骨骨折 带锁髓内钉 髓内扩张自锁钉 

分 类 号：R687[医药卫生—骨科学]