交锁髓内钉治疗胫骨远端开放性骨折

Open distal tibial fracture treated with intramedullary nailing

目的探讨交锁髓内钉治疗胫骨远端开放性骨折疗效。方法26例胫骨远端开放性骨折患者,先清创或牵引复位外固定,再闭合或小切口切开复位交锁髓内钉内固定。结果患者均获随访,时间7～22(15.2±3.3)个月。骨性愈合时间3.5～15.5(7.3±2.8)个月。术后功能恢复按Johner-Wruhs标准:优16例,良8例,可2例。可2例中1例出现骨折延迟愈合、断钉,经更换髓内钉并植骨后5个月获骨性愈合;1例皮肤坏死,经清创后Ⅱ期植皮愈合,遗留踝关节功能障碍。结论交锁髓内钉治疗胫骨远端开放性骨折是一种有效方法。

Objective To explore the effect of intramedullary nailing in treatment of distal tibial metaphyseal open fracture.Methods Twenty-six open distal tibial metaphyseal fractures were treated with interlocking intramedullary nailing with close or mini-incision reduction after debridement and bone traction.Results All the patients were followed up by clinic and radiograph for 7~ 22（15.2±3.3） months.Bone healing time was 3.5~15.5（7.3±2.8） months.According to Johner-Wruhs standards of functional recovery,the results were excellent in 16 cases,good in 8,and fair in 2.Among the two fair cases,one case got delayed union and broken hardware,and bone healing was attained after revision intramedullary nailing plus autologous bone graft.The other case occurred necrosis of skin,and healed after debridement and skin graft,remaining ankle joint functional impairment.Conclusions Interlocking intramedullary nailing is an effective technique for treating distal tibial metaphyseal open fracture.