摘要
目的：评价交锁髓内钉与外支架治疗严重胫骨开放性骨折的临床疗效。方法：严重胫骨开放性骨折患者39例，采用单侧外固定支架固定19例，男13例，女6例；年龄19～72岁，平均39岁；稳定性骨折7例，不稳定性骨折12例；合并其他部位骨折7例，颅脑损伤1例，腹部损伤2例。采用交锁髓内钉固定20例，男14例，女6例；年龄22～70岁，平均42岁；稳定性骨折8例，不稳定性骨折12例；合并其他部位骨折8例，颅脑伤2例，腹部伤1例。两组最初的伤口清创、软组织缺损的皮瓣移植修复是相同的。结果：随访时间平均为20个月（18—35个月），交锁髓内钉组骨折愈合时间（6．0±2．6）个月，外支架组骨折愈合时间为（7．0±2．5）个月。交锁髓内钉组膝关节的活动范围为115°±10°，踝关节为30°±5°，外支架组膝关节的活动范围为110°±5°，踝关节为27°±4°，髓内钉组功能恢复较好，成角畸形小。外支架组1例深部感染，4例钉道感染，髓内钉组1例深部感染。按功能评定标准，髓内钉组中优8例，良7例，中2例，差3例；外支架组中优4例，良5例，中3例，差7例。两组差异具有统计学意义（P〈0．05）。比较骨折愈合时间、部分负重时间、踝膝关节的活动范围，两组之间无显著性差异。结论：在彻底清创，并且具备即刻或早期皮瓣修复的技术条件下，交锁髓内钉是治疗严重胫骨开放性骨折的理想选择。
Objective：To analyse the effect of interlocking intramedullary nailing and external fixation for treatment of severe open tibial fractures. Methods：Thirty-nine patients with severe open tibial fracture were divided into two groups according to the fixation. Of 39 patients, 19 （13 male and 6 female; the average age of 39 years ranging from 19 to 72 years） were treated by interlocking intramedullary nailing. There were 7 cases of stable fracture and 12 of unstable fracture, complicating other fracture in 7 cases,craniocerebral injuries in 1 case,abdominal injuries in 2 cases;20 （ 14 male and 6 female;the average age of 42 years ranging from 22 to 70 years） were treated by external fixation. There were 8 cases of stable fracture and 12 of unstable fracture, complicating other fracture in 8 cases, craniocerebral injuries in 2 cases, abdominal injuries in 1 ease. Both groups had the same initial debridment and coverage of the soft-tissue defect with pedicled flaps. Results：The mean follow-up period was 20 months. In the interlocking intramedullary nail group, the time to fracture healing was （6. 0 ±2. 6） months,and the range of motion respectively was 115° ＋ 10°in the knee and 30° ＋5° in the ankle at the final follow-up. In the external fixation group, the time to fracture healing was （7.0 ± 2. 5 ） months, and the range of motion was respectively 110° ±5° in the knee and 27°±4° in the ankle at the final follow-up. The interlocking intramedullary nail group had slightly better motion and less final angulation. Complications included one deep infection and four pin-track infections in external fixation group and one deep infection in the external fixation group. According the function standard, in interlocking intramedullary nail group the result were excellent in 8 cases, good in 7 cases, fair in 2 cases, poor in 3 cases ; in external fixation group the result were excellent in 4 cases, good in 5 cases, fair in 3 cases, poor in 7 cases. There were significant statistical difference between two groups. The differences in fracture healing and range of motion were not statistically significant. Conclusion. With the ability to debride wound radically and transfer vascularized tissue into the traumatic defect,interlocking intramedullary nailing is the best choice for severe open tibial frcture.
出处
《中国骨伤》
CAS
2006年第8期478-480,共3页
China Journal of Orthopaedics and Traumatology
基金
广东省科技计划项目(编号:2005B33001031)
关键词
胫骨骨折
外固定器
骨折固定术
髓内
Tibial fractures
Extemal fixators
Fracture fixation,intramedullary
作者简介
通讯作者：晋大祥Tel：020—36591604E—mail：jindaxiang@21cn．com
