高能量创伤所致长管状骨骨折手术治疗分析与探讨

Surgical treatment of long bone fracture caused by high energy trauma

[目的]探讨高能量创伤所致长管状骨骨折的临床分型及手术治疗。[方法]自2001年至今长管状骨骨折病人76例按受创伤能量大小和骨折类型分为两组，高能量创伤所致长管状骨骨折组36例，低能量创伤所致长管状骨骨折组40例。所选病例中男性50例，女性26例。年龄18—55岁，平均31．3岁。其中股骨骨折17例，肱骨骨折18例，胫腓骨骨折41例。开放性骨折28例，闭合性骨折48例。高能量创伤组中对于骨两端结构相对完整的病例多数采用髓内钉有限内固定，少数采用长柄钢板做桥式固定；对于合并有骨的一端或两端有纵向爆裂骨折的病例采用螺丝钉加钢板桥式固定的方法固定。低能量创伤组采用带锁髓内钉和加压钢板内固定。2组病人手术后予以外固定4．10周，然后在医生指导下功能锻炼。[结果]所有病例均获随访，平均随访18个月。按长管状骨骨折术后功能评价标准将术后关节功能分为优、良、一般Ⅲ级，结果高能量创伤组手术后优良率83．33％，低能量创伤组手术后优良率95.00％。[结论]高能量创伤所致长管状骨骨折的手术治疗有一定困难，预后较低能量创伤所致骨折差。但只要根据骨折的不同类型，选择合适的内固定方式，结合适当外固定及合理的功能锻炼，仍能取得较为满意的疗效。

[ Objective ] To study the surgical treatment of long bone fracture caused by high energy trauma. [ Method ] Seventy-six patients with long bone fractures were divided into two groups based on energy intensity and fracture types ： group A, long bone fractures caused by high energy trauma （36 cases） ; group B, long bone fractuers caused by low energy trauma （40 cases）. For group A, intramedullary nail limited fixation was used for cases with relative integration of two ends of bone, and long DHS plate for bridge fixation in a few cases ; if one or both ends of bone showed bursting fracture, screw and plate were adopted for bridge fixation. For group B, intramedullary self-locking nail or compression plate fixation were applied. Four to ten weeks external immobilization and subsequent rehabilitation measures were taken postoperatively. The results were evaluated. [ Result] All cases got follow-up with average 18 months. Functional results were excellent and good of 83.33% in group A, while 95.00% in group B. There were one case of delay-union in both groups ; 5 cases with joint pain and limitation of activity in group A and 1 case in group B ; 2 cases with limb shortening in group A. [ Conclusion ] Surgical treatment of long bone fractures caused by high energy treauma was more difficult and its prognosis is worse than that caused by low energy trauma with no statistically significant difference（P 〉0.05）. Satisfactory results can still be possible if suitable fixation, adequate external immobilizaiton and rational rehabilitation measures were choosed case by case according to the different fracture types and impaired soft tissue.