扩髓的带锁髓内钉治疗胫骨不稳定骨折

Unstable Fractures of the Tibia Treated with a Reamed Intramedullary Interlocking Nail

作者回顾了２６例不稳定的胫骨骨折，均采用扩髓的带锁髓内钉治疗。其中闭合骨折１９例，开放骨折７例。除了３例闭合骨折失访，其余２３例骨折平均随访２０．４个月（３～６３个月）。最终结果评分采用Ｊｏｈｎｅｒ－Ｗｒｕｈ评分标准，在１６例闭合骨折中，最终评定结果优１３例，良２例，中１例；在７例开放骨折中，优３例，良２例，差２例。骨折平均愈合时间，闭合骨折１３周（８～２０周），开放骨折３０．５周（１２～９６周）。随访的１６例闭合骨折半年内均愈合；在７例开放骨折中，有１例骨折延迟愈合，时间超过１年，其余均在半年内愈合。闭合骨折随访１６例，无１例感染。７例开放骨折有２例感染，其中１例造成骨折延迟愈合。以上２６例病人手术后均无继发性骨筋膜室综合征、神经损伤、钉体或锁钉断裂等情况。作者认为扩髓的带锁髓内钉非常适用于闭合的胫骨不稳定骨折，而在治疗开放的胫骨骨折时，因为感染率高，应谨慎使用。

Twenty six unstable fractures of the tibia treated with a reamed intramedullary interlocking nail were reviewed.There were 19 closed and 7 open fractures.Twenty three patients were followed up for an average of 20.4 months (ranged 3 to 63 months) and evaluated according to the criteria of Johner and Wruh.In the closed fractures,there were 13 assessed as excellent,2 as good and 1 as fair.In the open fractures,there were 3 assessed as excellent,2 as good and 2 as poor.The time for fracture union averaged 13 weeks in closed fractures and 30.5 weeks in open fractures.All the closed fractures healed up within 6 months at the final follow up study.In open fractures,delayed union (>6 months) developed in one patient.There were no postoperation compartment syndromes,neurological deficits,broken nails and screws in this series.The authors concluded that the reamed intramedullary nails is indicated only for the unstable closed tibial shaft fractures and it should not be recommended for an open fracture because of the unacceptably high infection rate.