胫腓骨骨折三种固定方法比较  

A comparion of three fixation methods for the treatment of fractures of the tibia and fibula

作　　者：方成[1] 林成君[1] 吴友利[1] 

机构地区：[1]安徽淮南矿业集团第三矿工医院骨科,232001

出　　处：《中国基层医药》2003年第10期1006-1007,共2页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的　对胫腓骨骨折不同治疗方法比较分析 ,探讨最佳治疗方案。方法　本组治疗新鲜骨折118例 ,开放性骨折 6 7例 ,根据Gustilo标准分型[1] :Ⅰ型 2 7例 ,Ⅱ型 2 3例 ,Ⅲ型 17例 ,闭合性骨折 5 1例。外固定支架治疗 4 7例 ,角形加压钢板治疗 37例 ,带锁髓内钉治疗 34例。结果　平均随访 16个月 ,112例骨折愈合 ,平均愈合时间 6 3个月 ,6例骨折不愈合 ,骨折畸形愈合 7例。外固定支架组优良率 80 8% ,骨折平均愈合时间 6 7个月 ,骨感染 2例 ,骨畸形愈合 3例 ,骨不连 2例 ,关节功能障碍 3例。角型钢板组优良率72 9% ,骨折平均愈合时间 7 9个月 ,骨感染 2例 ,骨畸形愈合 2例 ,骨不连 3例 ,关节功能障碍 7例。带锁髓内钉组优良率 94 1% ,骨折平均愈合时间 5 7个月 ,骨感染 1例 ,骨畸形愈合 2例 ,骨不连 1例 ,关节功能障碍1例。经 χ2 检验三者差异有显著意义 (χ2 =10 97,P <0 0 5 )。结论　胫腓骨骨折应首选带锁髓内钉固定 ,对软组织损伤重的可使用外固定支架固定 ,钢板组优良率较低 ,远期并发症多 ,应减少使用。Objective To study the optimum project of treatment by means of the comparation of different treatment of the tibia and fibula fracture.Methods One hundred and eighteen cases of fresh fractures were reviewed,which included opened fracture(67 cases) and closed fracture(51 cases).According to Gustilo classification,type Ⅰ,Ⅱ and Ⅲ was 27,23,17 cases,respectively.In all cases,external fixation was performed in 47 cases,dynamic compression plate(DCP) in 37 cases,interlocking intramedullary nail in 34 cases.Results Followed up was performed for an average 16 months.We found that 112 cases healed,whose average healing time was 6.3 months,6 cases were nonunion.The results showed the excellent and effective rate was 80.8% in external fixation(average healing time was 6.7 months,the rate of complications was 21.2%).The excellent and effective rate was 72.9% in DCP(average healing time 7.9 was months,the rate of complications was 37.8%).The excellent and effective rate was 94.1% in interlocking intramedullary nail(average healing time was 5.7 months,the rate of complications was 14.7%).There were signification difference in the three groups(χ 2=10.97,P<0.05).Conclusion Interlocking intramedullary nail is the best methods for treatment of the tibial and fibular fracture,external fixation is a efficient method for treatment of the tibial and fibular fracture with severe soft tissue injury,the excellent and good rate is the lowest in DCP,further more,long-term complications of which is more.So the method should be reduced to be applied.

关 键 词：胫腓骨骨折 外固定支架治疗 角形加压钢板治疗 带锁髓内钉治疗 

分 类 号：R687.3[医药卫生—骨科学]