胫腓骨开放性粉碎性骨折髓内钉固定扩髓对局部血供及骨折愈合的影响  

Effects of reamed intramedullary nailing fixation on local blood flow and strength of union following open comminuted fracture of the tibia

作　　者：范卫民[1] 王道新[1] 李翔[1] 

机构地区：[1]南京医科大学第一附属医院骨科,210029

出　　处：《中华创伤杂志》2000年第5期263-265,共3页Chinese Journal of Trauma

摘　　要：目的　探讨胫腓骨开放性粉碎性骨折髓内钉固定时 ,扩髓对胫骨血流量和骨折愈合强度的影响。　方法　选用杂种犬 2 0只 ,随机分成两组 ,每组 10只。所有动物模拟右侧胫腓骨开放性粉碎性骨折 ,一组扩髓后行交锁髓内钉固定 ,另一组髓内钉固定前不扩髓。应用激光多普勒血流测量仪 ,测量髓内钉固定前后骨折端血供情况 ,术后 2 ,6 ,12周再次测量骨折端血供情况。每次测量后摄片检查。第 12周处死动物 ,取出髓内钉 ,以胫腓骨标本做生物力学测试。　结果　 (1)髓内钉固定后 ,非扩髓组骨折端平均血流量为 (4 6± 9)mV ,扩髓组为 (2 3± 6 )mV ,两组有非常显著性差异 (P <0 .0 1)。此后扩髓组血供恢复缓慢 ,至第 12周血供仍未恢复到骨折前水平。 (2 )X线片显示 ,扩髓组骨折均愈合不良或不愈合 ;而非扩髓组除 1只外 ,均愈合良好。 (3)生物力学测试显示 ,扩髓组骨折愈合强度较非扩髓组差。　结论　胫腓骨开放性粉碎性骨折行髓内钉固定时 ,扩髓对骨折端的血供和骨折愈合强度有明显影响。建议临床上对胫腓骨开放性粉碎性骨折行髓内钉固定时 。Objective [WT5”BZ]To explore the effects of reamed and unreamed locked intramedullary nailing on local blood flow and strength of union following open comminuted fracture of the tibia. [WT5”HZ]Methods [WT5”BZ]Twenty dogs were selected. After creation of an open comminuted fracture of the tibia, each tibia was stabilized with insertion of a locked intramedullary nail. Twenty dogs were allocated randomly into two groups. One group was reamed prior to nail insertion and the other was not. Blood flow was measured with laser Doppler flowmeter. The bone perfusion was determined at the fracture site at six time intervals ( pre-, and post-fracture, post-nail insertion, and 2, 6, and 12 weeks after operation). All animals were killed at the 12th week postoperatively. The nails were removed, and a biomechanical test was made. [WT5”HZ]Results[WT5”BZ] (1) Nailing with reaming resulted in a larger decrease in bone perfusion than nailing without reaming ( P <0.01). (2) Radiographs showed that the tibiae with reamed nails were not healed radiographically, but the tibiae with unreamed nails were healed well except one. (3) Strength of union in the reamed group was much less than that of unreamed group. [WT5”HZ]Conclusions [WT5”BZ]Reaming may significantly decrease the bone perfusion and strength of union. Therefore unreaming or limited reaming deserves recommendation in the treatment of open comminuted tibial fracture with interlocked intramedullary nail.

关 键 词：胫腓骨骨折 骨折固定术 髓内钉 骨折愈合 

分 类 号：R683.42[医药卫生—骨科学]