带锁髓内钉治疗胫骨干骨折396例疗效分析  

The Curative Effect Analysis of Interlocking Intramedullary Nail for the Treatment of Tibia Fracture

作　　者：胡广州[1] 靳安民[1] 刘宁富[1] 蔡保塔[1] 童斌辉[1] 

机构地区：[1]南方医科大学珠江医院骨科,广州510282

出　　处：《中国中医骨伤科杂志》2007年第7期14-16,共3页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的：通过应用带锁髓内钉内固定治疗胫骨干骨折396例的临床观察，评价其疗效并探讨并发症的处理方法。方法：自1994年6月至2004年8月应用带锁髓内钉（国产、进口）内固定治疗胫骨干骨折396例，其中双侧21例，共417侧。国产的296侧，进口的121侧。男性301侧，女性116侧。平均年龄33．4岁，闭合骨折282侧，按AO分型：A型63侧，B型81侧，C型138侧。开放性骨折135例，按Gustilo分型：Ⅰ型97侧，Ⅱ型38侧。X线监视下闭合复位内固定86侧，切开复位内固定331侧，静力固定334侧，动力固定83侧。结果：平均随访时间为10年2个月（28～96个月），406侧骨折获得愈合，愈合率为（97．36％）。并发症：一期骨折不愈合11侧（3％），感染7侧（1．7％），医源性血管伤1例（O．2％），医源性骨折2例（O．4％），脂肪栓塞1例（0．2％），畸形愈合6侧（1．4％），骨内痛31例（7．4％），膝关节痛48例（11．5％），断钉3侧（0．7％）全为国产钉。结论：1．带锁髓内钉治疗胫骨干骨折适应证广创伤小，固定牢固，功能恢复快。2．非扩髓动力固定骨折愈合快。3．延迟愈合者应改为动力性固定以加快愈合。4．不连接再次手术时应扩髓，植骨要充分，采用静力固定。5．术后1d开始借助CPM恢复膝和踝关节功能。Objective：To probe the effects of interlocking intramedullary nail fixation in the treatment of tibia fractures, to evaluate the application of intramedullary nail fixation treatment of tibia fractures and to explore the complication and their management. Methods： Three hundred and ninety-- six cases were retrospectively studied with tibia fractures treated by interlocking intramedullary nail from June 1994 to August 2004. Among them, there were bilateral in 21 cases, and 417 leg in total,including 301 male and 116 female with the average of 33.4 years, （ranging from 17--66 years）. According to the AO classification of closed fractures in 282 legs, there were 63 type A, 81 type B and 138 type C. According to the Gustilo of open fractures in 135 legs, there were 97 type Ⅰ and 38 type Ⅱ. With the image intensifier,86 fractures were reduced closely and fixation ,while 335 fractures failed to be reduced by the required open reduction. 334 fractures were stabilized statically, and 83 dynamically. Results： Among the 417 fractures,the mean follow--up period is ten years and two months （28-- 122 months）. Union was in 406 eases , union rate was 97.36%. There was nonunion in 11 patients （3%） ,there were infections occurred in 7 patents（1. 7%）. Iatrogenic injury was occurred in 1 patent （0.2%）. Iatrogenic fractures occurred in 2 patents （0.4%）. And it has been found that fat embolism syndrome in 1 patent （0.2%）,malunion in 6 patents （1.4%）, tibia pain in 31 patents （7.4%）, knee joint pain in 48 patents （11.5% ）, the interlocking nail fragmentations in 3 patents （0. 7%）. Conclusion： 1. Interlocking intramedullary nail.is suitable for tibia fractures because it can result in more reliable fixation ,less operative trauma . 2. Undreamed dynamically fractures were eventually healed fast. 3. Delayed healing must be used undreamed dynamically motivation fracture heal . 4. Patients must be reamed and graft bone completely, and stabilize statically,when nonunion is reoperated.

关 键 词：带锁髓内钉 胫骨骨折 并发症 疗效 

分 类 号：R683.42[医药卫生—骨科学]