闭合或有限切开复位交锁髓内钉固定治疗胫骨多段骨折

The treatment of segmental tibal fracture with closed or limited open reduction and interlocking intramedullary nail

目的:探讨闭合或有限切开复位交锁髓内钉固定治疗胫骨多段骨折的方法和疗效。方法:选择性对20例胫骨多段骨折患者采用闭合或有限切开复位交锁髓内钉固定,其中,闭合性骨折16例,开放性骨折4例。术后平均随访13.5个月,观察患肢的功能恢复及临床并发症。结果:19例患者骨折平均5个月愈合,1例患者术后因远端锁钉断裂未愈合;2例发生伤口局部浅表感染,2例发生局部皮肤软组织坏死。按Johner-Wruhs胫骨干骨折疗效评定标准,优15例,良4例,差1例。结论:闭合或有限切开复位交锁髓内钉固定治疗胫骨多段骨折手术创伤小,固定牢靠,有利于骨折愈合,是治疗胫骨多段骨折的有效方法。髓内钉的选择、手术的规范操作及小腿软组织损伤程度是影响术后并发症的关键因素。

Objective： To investigate the method and clinical efficacy of closed or limited open reduction and interlocking intramedullary nail in the treatment of segmental tibial fractures. Methods： 20 cases of segmental tibia/ fractures were treated with closed or limited open reduction and interlocking intramedullary nail.16 patients with close fractures and 4 patients with open fractures.All patients were fallowed up for average 13.5 months.Outeoms were assessed by Johner-Wruhs evaluation criteria and postoperative complications. Results： 19 cases obtained fracture union in average 5 months,/ case suffered from non-union after operation because of distal locking screw breakage,2 cases suffered from wound infection,2 eases suffered from soft tissue necrosis. According to Johner-Wruhs evaluation criteria, 15 cases were excellent,4 cases were good,1 case were poor. Conclusion： The method with closed or limited open reduction and interlocking intramedullary nail in treatment of segmental tibial fractures has minimal operation invasion, the fixation is stable, which is benefit to the fracture union.It is an effective method in treatment of segmental tibal fracture.The intramedullary nail choice, scientifically operating and soft tissue injury are crucial to preventing complications.