可膨胀髓内钉与传统交锁髓内钉在胫骨干骨折中的应用对照研究

COMPARISON STUDY BETWEEN FIXION EXPANDABLE INTRAMEDULLARY NAIL AND TRADITIONAL LOCKED INTRAMEDULLARY NAIL IN TREATING CLOSED FRACTURE OF TIBIAL SHAFT

目的探讨可膨胀髓内钉Fixion系统治疗胫骨干骨折的疗效,与传统交锁髓内钉比较临床效果。方法回顾2005年9月1日～2006年8月31日,79例采用髓内钉系统治疗的新鲜闭合性胫骨干骨折。其中男53例,女26例;年龄17～57岁,平均37岁。按AO分型均为42A或42B型。应用可膨胀髓内钉组31例,其中42A型24例,42B型7例;传统交锁髓内钉组48例,其中42A型37例,42B型11例。术后定期随访,观察骨痂出现时间、临床愈合时间,有无畸形愈合、延迟愈合、不愈合、感染等并发症,评价肢体功能。结果79例均获得4～15个月随访,平均10.3个月。可膨胀髓内钉组：手术时间20～60min,平均35min,均未输血;X线片示最早出现骨痂为术后4周,临床愈合时间为3～8个月,平均5个月;全部获期愈合;按Johner-Wruhs方法评价功能,优28例,良3例,差0例,优良率100%。传统交锁髓内钉组：手术时间45～110min,平均75min,均未输血;X线片示最早出现骨痂为术后4.5周,临床愈合时间为3～12个月,平均5.8个月;期愈合46例,期愈合2例;按Johner-Wruhs方法评价功能,优35例,良11例,中2例,优良率95.8%。结论可膨胀髓内钉系统具有微创、操作简便、可早期负重、骨折愈合快及并发症少等优点,但必须严格控制适应证。

Objective To investigate an effect of the Fixion expandable intramedullary nail on treatment of the closed fracture of the tibial shaft, and to compare the Fixion nail with the traditional locked intramendullary nail. Methods From September 1, 2005 to August 31, 2006, 79 patients （53 men, 26 women; aged 17-57 years, 37 years on average） with the closed fracture of the tibial shaft were treated with the Fixion expandable intramedullary nail, and the effect of the nail was evaluated. According to the AO classification, the patients were typed as Type 42A or Type 42B. And the patients were divided into the following two groups; the expandable intramedullary nail group （n=31） and the traditional locked intramedullary nail group （n=48）. Of the 31 patents in the first group, 24 were of Type 42A and 7 were of Type 42B; of the 48 patients in the second group, 37 were of Type 42A and 11 were of Type 42B. All the patients were followed up after operation. Observation was made on the time of the bony callus development and the time of the clinical healing of the bone, and on whether there was the bone malunion, late healing, disunion or infection. The limb function was also evaluated. Results The follow-up of all the 79 patients for 4-15 months averaged 10. 3 months revealed that in the expandable intramedullary nail group, the average operating time was 35 minutes （range, 20-60 minutes）, with no requirement of blood transfusion. The X-ray examination showed that the bony callus developed as early as 4 weeks after operation. The clinical healing time of the bone was 3-8 months, averaged 5 months. All the patients in this group had the healing by first intention. Evaluated by the Johner-Wruhs method, an excellent result was found in 28 patients, good in 3 patients, and poor in none of the patients, with an excellent/good rate of 100%. In the traditional locked intramedullary nail group, the average operating time was 75 minutes （range, 45-110 minutes）, with no requirement of blood transfusion. The X-ray examination showed that the bony callus developed as early as 4.5 weeks after operation. The clinical healing time was 3-12 months, averaged 5.8 months. In this group, 46 patients had the healing by first intention and 2 patients had the healing by second intention. Evaluated by the Johner-Wruhs method, an excellent result was found in 35 patients, good in 11 patients, and fair in 2 patients, with an excellent/good rate of 95. 8%. Conclusion The expandable intramedullary nail treatment has advantages of less invasion, simpler manipulation, earlier weight-bearing of the bone, quicker healing of the bone fracture, and fewer complications. This kind of treatment is worth popularizing in the medical practice if the indication is strictly controlled.