扩髓与非扩髓交锁髓内钉治疗胫骨骨折的疗效比较  

A clinical study on comparing the result of the treatment of tibial shaft fractures using reamed or non-reamed nails

作　　者：林研[1] 印心奇[1] 董天华[2] 徐根宝[1] 顾小华[3] 彭庄[1] 

机构地区：[1]上海市东方医院骨科,200120 [2]苏州大学附属第一医院骨科 [3]上海市第七人民医院骨科

出　　处：《中华创伤杂志》2001年第12期709-712,共4页Chinese Journal of Trauma

摘　　要：目的　比较临床闭合复位下扩髓与非扩髓交锁髓内钉治疗闭合或轻度开放胫骨骨折的疗效。　方法　 1998年 3月～ 1999年 12月对 12 6例共 12 9侧胫骨骨折采用闭合复位交锁髓内钉治疗。术前分为非扩髓组 5 8侧 ;扩髓组 71侧。骨折为闭合骨折或Ⅰ、Ⅱ度开放骨折。定期随访 1年以上。　结果　非扩髓组与扩髓组髓内钉平均直径分别为 8.8mm、9.4mm(P <0 .0 0 1) ;术后发生筋膜间隔综合征分别为 2例、1例 ,其中非扩髓组有 1例切开减压 ;无全身感染 ,局部感染分别为 3例、2例 ;非扩髓组 1例髓内钉断裂、4例锁钉断裂 ,扩髓组无断钉 ;平均骨折愈合时间分别为116d、10 2d(P <0 .0 0 1) ;延迟愈合分别为 2例、1例 ;非扩髓组有 1例骨折不愈合。　结论　与非扩髓组比较 ,扩髓交锁髓内钉具有骨折固定强度大、并发症少、骨折愈合快、延迟愈合或不愈合少等优点。Objective To prospectively compare the clinical results of the treatment of tibial shaft fractures using reamed or non reamed nails. Methods From March 1998 to December 1999, 129 tibial shaft fractures (from 126 cases) were treated with interlocking intramedullary nails. There were 58 fractures in the non reamed group (Group A) and 71 fractures in the reamed group (Group B). Most of them were closed fractures. Ten cases belonged to GestiloⅠand Ⅱ(5 7 days after injury). All patients were followed up regularly for more than 1 year after operation. Results The average diameter of nails was 8.8 mm in Group A and 9.4 mm in Group B ( P <0.001). There were 2 cases complicated by compartment syndrome in Group A, in which 1 needed decompression operation. One patient in Group B was also complicated by compartment syndrome but operation was unnecessary. No systematic infection happened but local infection occurred in 3 cases in Group A and 2 in Group B. One broken nail and 4 broken wires were found in Group A but none in Group B. The average healing time of the frature in Group A was 116 days while it was 102 days in Group B ( P < 0.001 ). Two cases of delayed union occurred in Group B and 1 case in Group A. Conclusions In comparison with the non reamed nail, reamed nail can attain firm fixation, less complications, more rapid healing and less delayed union and nonunion.

关 键 词：胫骨骨折 髓内固定术 髓内钉 

分 类 号：R687.3[医药卫生—骨科学]