摘要
自60年代以来,坚强固定和有关骨折内固定治疗的原则一直被AO/ASIF学组所推荐.加压钢板和髓内钉的设计和应用技术也有较大进展.然而仍存在些有争议的问题.如坚强固定可引起应力遮挡,无论采用加压钢板或髓内钉治疗长骨粉碎骨折,骨不连和内固定器材破坏的发生率仍然高.在临床和实验研究的基础上,作者强调AO/ASIF学组提出的某些基本原则有必要修改和(或)补充.在切开复位时如骨折部,特别是压力侧有骨缺损,必须采用髓内、外植骨修复,否则内固定器材承受的应力比无骨缺损时将增加5~10倍.骨折早期固定应该比较坚强,后期肢体负重时应为弹性固定.这样不仅有利于骨折愈合,而且有利于骨的模造.两者可通过合理使用优化设计的内固定器材结合起来.在骨折治疗中,如练功或负重后骨折断端出现骨吸收,这是固定不牢和骨折端活动太多的一个信号.一旦出现骨吸收,则应限制练功活动并避免负重,直至骨折部形成连续外骨痂再恢复活动.
Since1960'therigidfixationandrelatedprinciplesfortreatmentoffractureswithinter-nalfixationhavebeenrecommendedbyAO/ASIFGroup.Thedesignandtheapplicatedtechniquesofeithercompressionplateorintramedularynailhavealsomaderathergreatprogress.However,somecontroversialproblemsstilremain.Rigidfixation,forinstance,maycausestressshielding.Theinci-denceofnonunionand/orbreakageofimplantwasstilhighinthetreatmentofcomminutedfracturesoflongbones,nomaterwhatkindofimplant,compressionplateorintramedularynailwasused.Basedonclinicalandexperimentalstudies,theauthorsemphasizedthatsomebasicprincipleswhichwerepro-posedbyAO/ASIFGroupshouldberevisedand/orsupplemented.Inopenreduction,ifthereisanybonedefectatthefracturesite,especialyonthecompressionside,shouldberepairedbyonlayandin-laybonegraft.Otherwise,thestresssubjectedtotheimplantisabout5~10foldgreaterthanthatwithoutbonedefect.Immobilizationoffractureshouldberelativelyrigidintheearlystageandelasticinthelaterstageduringweight-bearing.Itisbeneficialnotonlyforfracturehealingbutalsoforbonere-modeling.Bothofthemcanbeintegratedbyrationaluseofoptimaldevices.Duringthetreatment,iftheboneresorptionappearsatthefragmentendsafterdoingexercisesortakingweight-bearing,itisasignalwhichshowsthatthefixationisunstableandthemotionatthefracturesiteistoomuch.Oncetheboneresorptionappears,theexerciseshouldberestrictedandtheweight-bearingmustbeavoided.Ifnecessary,someexternalfixation,castslaborsplints,canbeapplieduntilthecontinuouscalusformsaroundthefracturesite.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
1996年第4期204-207,共4页
Chinese Journal of Orthopaedics
关键词
骨折
内固定术
FractureBonedefectBonereconstructionInternalfixation