下肢长骨多段骨折的治疗

TheTreatmentofMultipleSegmentalFractureoftheLongBoneoftheLowerLimb

自１９８４年１０月～１９９３年４月共收治下肢长骨多段骨折１６例，９例为股骨多段骨折，７例为胫骨或胫、腓骨多段骨折。作者对该类骨折的临床特点、整复方法及治疗选择做了探讨。作者认为：该类骨折采用Ｅｎｄｅｒ针内固定是目前最好的适应证。因为：（１）Ｅｎｄｅｒ针固定可采用闭合复位；（２）Ｅｎｄｅｒ法手术时间短，切口小，创伤小；（３）Ｅｎｄｅｒ针较Ｋｕｎｔｓｃｈｅｒ针固定范围广。特别在股骨转子部骨折或股骨下１／３骨折不适合于Ｋｕｎｔｓｃｈｅｒ针固定，而Ｅｎｄｅｒ针可提供较好的固定。本组经Ｅｎｄｅｒ针闭合治疗的病例，所有骨折，除１例并股骨颈骨折者外，均获得良好骨性愈合，经随诊均获得满意结果。

FromOctober1984toAptil1993,16casesofmultiplesegmentalfracturesofthelongbonesofthelowerlimbweretreated;9hadfemoralmultiplesegmentalfracturesand7hadtibialortibio-fibularmultiplesegmentalfractues.Reviewofthesecasesrevealedthat,forthesetypesoffrac-tures,treatmentwithEndernailingwasindicated.Thereasonsare:1.Ender'smethodofin-tramedularynailscanbedonewithclosedmanner;2.thetimeofsurgerywasshortandbloodlosssmal;3.iftherewaseitheranassociatedpertrochantericfractureofthefemurorafractureofthedis-talportionofthefemurwheretheEndernailsgivebeterfixationthanKuntschernail.Inthisseries,exceptonecaseassociatedwithfractureofthefemoralneck,althefractrureshealedupwel.Therewasnomajorpostoperativeproblemsnoted.