夹板对股骨闭合复位内固定术后碎骨片的复位作用

Reduction effect of splint on the bone fragments after closed reduction and internal fixation for femoral shaft fractures

目的：评估外用夹板对股骨粉碎骨折术后碎骨片的复位作用.方法：自2004年7月-2005年5月收治12例13侧股骨干粉碎骨折,男7例,女5例;平均年龄46.8岁.外伤后1周内施行闭合复位髓内钉内固定术,术中未对骨折处进行剥离固定,术后即刻摄片发现有大块的骨折片明显移位,股骨整体力线和长度恢复良好.予以夹板外固定2～4周,移位的骨折片处适当加压,每周摄片观察调整.结果：所有病例移位明显的骨折片在夹板固定1周后即有满意的复位,碎骨片向中心轴靠拢0.5～3 cm,无夹板造成的软组织挤压伤,创口Ⅰ期甲级愈合,骨折愈合时间平均16.2周,患侧髋、膝关节功能良好.结论：外用夹板对股骨碎骨片的复位疗效确切、方法简便,与微创内固定相互结合,明显提高疗效.

Objective：To evaluate the reduction effect of splint on bone fragments in the treatment of comminuted fracture of femur after internal fixation. Methods： From 2004. 7 to 2005. 5, 12 patients with comminuted fractures of femur（ 13 femurs） were treated with closed reduction and locked intramedullary nails fixation within 1 week after trauma. Among them ,7 patients were male and 5 patients were female, the mean age was 46. 8 years. During the operation, soft tissues attached to the fracture were not stripped. Postoperative instant X-ray showed that big pieces of bone fragment obviously separated from the shaft, but the mechanic line and length of femur shaft recovered well. Splints were used for 2 to 4 weeks to treat the movement and appropriate compression was added to the separated fragments. The splints were adjusted every week according to X-ray examination. Results： After the splints were applied for 1 week, the big separated bone fragments were reclosed to the femur shaft in all patients, and the gap between the bone pieces were shortened with 0. 5 to 3 cm. The average fracture healing period was 16. 2 weeks. No soft tissue was injured. All the affected hips and knees were recovered with good function. Conclusion： The externally-used splint is effective to reduce separated fragments in the treatment of femoral shaft fractures, and can be used easily. The splint in combination with minimal invasive internal fixation may obviously improve therapeutic effects.