带锁髓内钉治疗下肢骨折的并发症及防治

Causes of complications and prevention in the treatment of lower extremity fractures with intramedullary interlocking nails

目的:探讨带锁髓内钉治疗下肢长管状骨骨折的并发症原因,提出防治措施。方法:回顾性分析1998年3月-2004年5月用带锁髓内钉治疗的下肢长管状骨骨折101例,发生并发症共19例。锁钉放置失败3例,正确连接或更新瞄准器;术中新骨折2例,更换或辅以其他内固定;感染2例,足量应用敏感抗生素,创口引流、冲洗;延迟愈合2例,变静力为动力固定;骨不连1例,行拔钉、扩髓、换钉、植骨;再骨折4例,二次手术或制动;锁钉断裂、退出4例,未处置;肢体短缩1例,未处置。结果:锁钉放置失败、术中新骨折、延迟愈合、骨不连、术后再骨折、感染,共14例,均骨愈合。锁钉的断裂、退出4例,未影响骨愈合。肢体短缩1例,未影响骨愈合及正常生活。结论:运用带锁髓内钉治疗下肢长管状骨骨折严格掌握适应证及遵循静力和动力固定原则、彻底清创,是减少并发症的有效措施。

Objective：To study causes of the complications in the treatment of tubular bone fractures of lower extremities with intramedullary interlocking nails, and to explore its prevention and cure methods. Methods： Form March 1998 to May 2004,101 patients with tubular bone fractures of lower extremities were treated with intramedullary interlocking nails. Among the patients 19 patients had complications, 3 patients who were failure in putting interlocking nails were treated with changing new aimer and handle carefully,2 patients who were new fractures during the operation were treated with changing or adding other internal fixation, two patients with infections were treated with sensitive antibiotic associated with draining and washing wound, two cases of delayed union were treated with converting the fixation from static to dynamic, 1 patient with non-union was treated with removing locking nails, enlarging intramedullary tunnels, exchanging nails and bone grafting,4 cases of re-fracture were treated with second operation and immobilization, 4 cases of interlocking nails broken or exiting were not treated with any disposal because of its no effect on bone healing, and 1 patient with limb shortening was also treated with no any disposal. Results： In the 14 patients with such complications as failure place of interlocking nails, new fractures during the operation, delayed union, non-union, postoperative re-fractures and re-infectious, the fractures were finally healed. Interlocking nails were broken and existed in 4 patients. No effect on bone healing was achieved in 4 patients whose interlocking nails were broken or exited. One patient with limb shortening can live with normal life and have bone healing. Conclusion： Controlling operative indication strictly and mastering principle of static and dynamic fixation, as well as completely debride- ment are effective measure to decrease complications in the treatment of extremity fractures with intramedullary interlocking nails.