超远端髓内钉结合阻挡螺钉治疗胫骨远端骨折  

Treatment of distal tibial fractures with ultra-distal tibial intramedullary nails combined with blocking screws

作　　者：孙文建[1] 沈国蔚[1] 杨永江[1] 顾章平[1] 

机构地区：[1]南京明基医院,南京医科大学附属医院骨科,210019

出　　处：《中华创伤杂志》2014年第6期537-540,共4页Chinese Journal of Trauma

摘　　要：目的总结超远端髓内钉结合阻挡螺钉治疗胫骨远端骨折的手术方法，评估该方法的临床疗效。方法2008年4月-2012年9月应用超远端髓内钉结合阻挡螺钉治疗21例胫骨远端骨折患者，均采用闭合复位、不扩髓技术、静力固定。对相对简单骨折在常规插入髓内钉后骨折复位和稳定性不满意，即拔除髓内钉置入阻挡螺钉；对严重粉碎骨折，直接在透视下置入阻挡螺钉。术后3周允许患肢部分负重行走，随访评估骨折复位、骨愈合和功能恢复情况。结果平均随访17．5个月（12—22个月），无皮肤坏死、软组织和骨性感染发生。所有骨折均愈合，平均愈合时间12．5周（8～26周），X线片测量骨折部位在冠状面、矢状面平均成角〈5°，无阻挡螺钉及髓内钉变形、断裂等情况。参照Tormetta功能评分标准：优19例，良2例。结论治疗胫骨远端骨折时，阻挡螺钉通过缩小髓腔直径辅助骨折复位、提高固定稳定性，扩大了髓内钉的应用范围。Objective To determine the surgical procedures and effects of ultra-distal tibial intramedullary nails combined with blocking screws in treatment of distal tibial fractures. Methods From April 2008 to September 2012, 21 cases of distal tibial fractures were treated with ultra-distal tibial intramedullary nails combined blocking screws. All fractures were statically locked and closed using undreamed technique. For relatively simple fracture, blocking screws were considered when the reduction and stability was not satisfied after the insertion of intramedullary nails; for severe comminuted fractures, blocking screws were inserted directly under C-arm fluoroscopy. Partial weight-bearing was permitted 3 weeks after surgery. Quality of reduction, fracture union, and function assessment were measured at follow-up. Results No skin necrosis and soft tissue and bone infections occurred after a mean follow-up of 17.5 months （range, 12-22 months）. All fractures were healed with an average healing time of 12 months （range, 8-26 months）. X-ray findings revealed the fracture of 〈 5° angulation on coronal and sagittal planes. There was no deformation or breakage of blocking screws and intramedullary nails. Ac- cording to the criteria of Tormetta, the results were excellent in 19 cases and good in 2. Conclusion Blocking screws assists reduction and improve the fixation stability by narrowing the canal in treatment of distal tibial fractures and expands the application of intramedullary nails.

关 键 词：胫骨骨折 骨折固定术 内 髓内钉 

分 类 号：R687.3[医药卫生—骨科学]