一期应用交锁髓内钉和/或AO外固定架治疗双侧胫骨骨折

Surgical treatment of bilateral tibial fracture with interlocking intramedullary nail and/or AO external fixator

[目的]探讨一期应用交锁髓内钉和/或AO外固定架治疗双侧胫骨骨折的临床价值和相关问题。[方法]回顾性分析自1998年4月~2006年1月间一期应用交锁髓内钉和/或AO外固定架治疗双侧胫骨骨折33例66肢。男26例,女7例;平均34.4岁。闭合骨折按AO/ASIF分型A型9肢;B型13肢;C型17肢。开放骨折按Gustio分型I型10肢;Ⅱ型6肢;ⅢA型5肢;ⅢB型4肢;ⅢC型2肢。受伤至手术时间平均为5.5d(3h^12d)。[结果]随访6个月~3年,平均16个月。66肢均达骨性愈合,骨折平均愈合时间闭合性骨折16周,开放性骨折18周,4肢延迟愈合。3肢发生浅表感染经保守治疗痊愈。按Johner-Wruh评分标准,结果优19例,良11例,可3例。优良率为90.9%。无脂肪栓塞综合征、深部感染,内固定失效及畸形愈合发生。[结论]一期应用交锁髓内钉和/或AO外固定架治疗双侧胫骨骨折操作简单,骨折端血运破坏少,固定确切,骨折愈合率高,可早期功能锻炼且疗效满意。固定方式应根据骨折类型选择最佳方法。

[ Objective] To evaluate the clinical value and relating problems in treating bilateral tibial fracture by using interlocking intramedullary nail and/or AO external fixator. [ Method] Totally 33 patients of bilateral tibial fracture treated with inter- locking intramedullary nail and/or AO external fixator from April 1998 to January 2006 were retrospectively reviewed. There were 26 males,7 females,with an average age of 34.4 years. According to the AO/ASIF classification ,there were type A 9 limbs,type B 13 limbs and type C 17 limbs. According to Gustilo classification there were type Ⅰ 10 limbs,type Ⅱ 6, mA 5 ,type ⅢB 4 and type ⅢC 2. Duration from injury to operation was 5.5 days（3 hour ～ 12 days）. [ Result] All patients were followed up for 6 ～ 36 months,with the average time being 16 months. All fractures had ben union. The union time averaged 16 weeks in closed fractures and 18 weeks in open fractures. Delayed union occurred in 4 limbs. There were 3 limbs of superficial infection. The results were excellent in 19 cases,good 11 cases,fair 3 cases according to the criteria of Johner-Wruh. Rate of excellent and good result was 90.9%. No fat embolism syndrome,deep in fection,failure of fixation and malunion were not found in this group. [ Conclusion] The advantages of interlocking intramedullary nail and/or AO external fixator in treatment of bilateral tibial fracture has advantages of easy performance, reduced destruction of blood supply to the fracture ends, rigid fixation, high union ratio of fractures, promotion of early functional extercise and satisfactory effect. The selection of the fixation device should be adopted according to the types of the fracture.