胫骨骨折外科手术方式的选择及其疗效比较(附245例报告)

Comparison with the different surgical treatment of the tibial fracture and the effects:Analysis of 245 cases

目的通过回顾分析我院近4年进行手术治疗的胫骨骨折患者245例,评价其不同手术方式的临床疗效。方法对96例带锁髓内钉固定患者、137例钢板固定患者及12例外固定支架固定患者的术后并发症、术后负重时间和术后功能恢复情况进行分析和总结。结果96例带锁髓内钉固定组患者下地负重时间平均为18天,皮瓣坏死2例,骨筋膜室综合征1例,感染2例,疗效优良89例,一般及差7例;137例钢板固定组患者下地负重时间平均为82.9天,皮瓣坏死16例,骨筋膜室综合征5例,感染6例,骨不连或畸形愈合5例,疗效优良115例,一般及差22例。12例外固定支架固定组患者平均下地负重时间为128.5天,皮肤坏死5例,感染3例,骨不连3例,疗效优良6例,差6例。相互之间比较有显著性差异(P<0.05)。结论对于闭合性胫骨骨折患者,首选带锁髓内钉治疗,对于GustiloⅠ、Ⅱ、Ⅲa型骨折患者,可选用髓内钉或钢板治疗。而对于GutiloⅢb及Ⅲc型骨折患者,忌用内固定治疗,首选外固定支架固定。

Objective To discuss the clinical effects of the surgical treatment of the tibial fractures of 245 patients in current four years. Methods Ninety-six patients with interlocking intramedullary nail fixation, 137 patients with steel plate fixation and 12 patients with external equipment fixation were analyzed for the complication, weight-bearing time after surgery and the recovery of the function. Results The patient treated with interlocking intramedullary nail acquired a good recovery comparing with the other two groups. Conclusion For a closed tibial fracture, the interlocking intramedullary nail is the first choice. But for a severe open tibil fracture, external equipment fixation is the best choice.