髌上入路交锁髓内钉治疗Gustilo-Ⅰ、Ⅱ型胫骨近端开放性骨折临床疗效观察  

Clinical effect of supra-patellar interlocking intramedullary nailing in treatment of Gustilo-Ⅰ, Ⅱ proximal tibial open fracture

作　　者：牛庆飞[1] 卢建新[1] 金家峰[1] 王浩然[1] 王硕[1] 

机构地区：[1]沈阳医学院附属中心医院骨外科,辽宁沈阳110024

出　　处：《生物医学工程与临床》2017年第4期413-415,共3页Biomedical Engineering and Clinical Medicine

摘　　要：目的探讨髌上入路交锁髓内钉治疗Gustilo-Ⅰ、Ⅱ型胫骨近端开放性骨折的临床效果。方法选择2014年6月至2016年6月收治Gustilo-Ⅰ、Ⅱ型胫骨近端开放性骨折患者18例,其中男性12例,女性6例;年龄25~60岁,平均年龄40.5岁。所有患者于伤后6~9 d行胫骨髌上入路交锁髓内钉内固定术,记录手术时间、术中失血量、术后并发症、住院时间、骨折愈合情况、关节功能、膝关节疼痛情况,采用胫骨骨折Johner-Wruh疗效评估标准和美国特种外科医院(HSS)膝关节功能评分标准进行疗效评价。结果 18例患者手术时间60~100 min,平均手术时间(76.6±9.1)min;术中失血量40~80 m L,平均出血量(53.6±6.8)m L;术后切口愈合良,无并发症。所有患者随访时间9~18个月,平均随访时间(13.5±4.6)个月;所有骨折均一期骨愈合,平均愈合时间(3.5±1.7)个月;所有患者均未出现膝前疼痛症状,JohnerWruh疗效评估优良率为94.4%,HSS膝关节功能评分优良率为94.4%。结论髌上入路髓内钉治疗Gusitlo-Ⅰ、Ⅱ型胫骨近端开放性骨折操作方便,并发症少,术后功能良好,疗效满意。Objective To study the clinical effect of supra-patellar interlocking intramedullary nailing in treatment of Gustilo-Ⅰ, Ⅱ proximal tibial open fracture. Methods From June 2014 to June 2016, 18 cases of Gustilo-Ⅰ, Ⅱ proximal tibial open fracture were enrolled, which included 12 males and 6 females, aged 25-60 years old with mean age of 40.5 years old. All of them were treated with interlocking intramedullary nailing internal fixation via supra-patellar approach in 6-9 days after injury. The operation time, blood loss volume, complications, hospitalization time, fracture healing, joint functions and knee pain were recorded. The knee joint function score was evaluated by Johner-Wruh score and Hospital for Special Surgery（HSS） score.Results The operation time of 18 cases was 60-100 minutes with mean operation time of（76.6 ± 9.1） minutes. The blood loss volume was 40-80 m L with mean blood loss volume of（53.6 ± 6.8） m L; All incisions healed well without any complications.All of them were follow-up 9-18 months with mean follow-up of（13.5 ± 4.6） months. The fractures were primarily healed, and the mean healing time of（3.5 ± 1.7） months. There was no anterior knee pain in patients and the excellent rate were 94.4 % and94.4 % in Johner-Wruh score and HSS score, respectively. Conclusion It is demonstrated that the treatment of Gustilo-Ⅰ,Ⅱ proximal tibial open fracture with supra-patellar intramedullary nailing is easy operated and less complication, which showed good postoperative function and satisfactory results.

关 键 词：髌上入路 交锁髓内钉 胫骨近端开放性骨折 

分 类 号：R687.3[医药卫生—骨科学]