BO原理在下肢粉碎性骨折治疗中的应用

Treating low extremity comminuted fracture with biological osteosynthesis

[目的]利用BO原理指导内固定材料在下肢粉碎性骨折的应用，减少骨折端的血供破坏，有助于骨愈合。[方法]针对所有类型的下肢粉碎性骨折，术中不剥离骨膜及游离碎骨片，要求间接对线复位，固定相对稳定。动力髁钢板固定粗隆下骨折18例、固定股骨下端粉碎性骨折16例；解剖钢板少钉固定粗隆下骨折26例、固定股骨下端粉碎性骨折24例；加压钢板少钉固定股骨干粉碎骨折27例、固定胫腓骨粉碎骨折3l例；LC-DCP少钉固定股骨干粉碎骨折26例、固定胫腓骨粉碎骨折22例；交锁髓内钉固定股骨干粉碎骨折25例、固定胫骨粉碎骨折18例；单臂外固定架治疗胫腓骨粉碎性骨折103例；单臂外固定架加有限螺钉治疗胫腓骨粉碎性骨折56例；有限螺钉加石膏或夹板治疗胫腓骨粉碎性骨折2l例。[结果]治疗413例，随访6～18个月，平均10．5个月，骨愈合408例，占98．78％。股骨骨折不愈合1例，畸形愈合2例（成角〉20°），胫腓骨骨折延迟愈合2例，不愈合4例。[结论]BO的间接对线复位、固定相对稳定及保护骨折端软组织等优点有利于骨折愈合，尤其适应于长骨干的粉碎性骨折。

[ Objective] To treat the low limb comminuted fracture with biological osteosynthesis as a guide in order to decrease damage of periosteal blood supply and increase the bone healing. [ Method] For all types of long bone comminuted fracture in low limbs, the operation was taken for keeping connection of bone fragment with periost, indirect reduction through mechanical line, relative stable fixation and there is no need for anatomical reduction. Eighteen cases of intertrochanteric comminuted fractures and 16 cases of low femoral comminuted fractures were treated with DCS. Twenty-six cases of subtrochanteric comminuted fractures and 24 cases of low femoral fractures were fixed with anatomical steel plate in less screws. Twenty-seven cases of femoral shaft comminuted fractures and 31 cases of tibia and fibula comminuted fractures were fixed with compressive plate in less screws. Twenty-six cases of comminuted fractures of femoral shaft and 22 cases of tibia ones were fixed with LC-DCP in less screws. Twenty-five cases of comminuted fractures of femoral shaft and 18 cases of tibia ones were fixed with locking intermedullary nails. One hundred and three cases of comminuted fractures of tibia and fibula were fixed with extra-fixture. Fifty-six cases of comminuted fractures of tibia and fibula were fixed by unilateral multi-purpose external fixing. Twenty-one cases of comminuted fractures of tibia and fibula were fixed by unilateral multi-purpose external fixing with limited screws and plaster. [ Result] A total of 413 cases had been treated and followed up within 6 - 18 months（ average 10.5 months）. Four hundred and eight cases had bone union and accounted for 98.46% in all cases. One case had nounion and two cases had malunion in femoral fracture. Two cases had delayed union and four cases had nounion in tibia fractures. [ Conclusion] It is useful for the bone blood supplying and healing with biological osteosynthesis of reducing bone fracture indirectly and fixing one relatively, especially for comminuted fracture of long bone shaft.