急诊交锁髓内钉内固定加锁钉开口处取骨植骨治疗胫骨中下段闭合性骨折

Open reduction with interlocking nail fixation and early bone graft for distal closed fractures of tibia in emergency

目的探讨急诊切开复位交锁髓内钉内固定加锁钉开口处取骨植骨治疗胫骨下段闭合性骨折的疗效。方法对26例胫骨下段闭合性骨折患者行切开复位交锁髓内钉内固定治疗,并行交锁髓内钉开口处取骨一期植骨。结果患者均获随访,时间7～26(15±3.6)个月。切口均愈合良好,无感染,无皮肤坏死。24例骨折3～5(3.8±0.4)个月完全愈合,2例延迟愈合,未出现骨不连。按Tenny和Wiss评分系统评价疗效:优21例,良3例,可2例。结论采用切开复位交锁髓内钉内固定加交锁髓内钉开口处取骨治疗胫骨下段闭合性骨折,能提高骨折一期愈合率,避免二期植骨手术和髂骨取骨的并发症。

Objective To investigate the clinical outcome of open reduction and internal fixation with interlocking bone nail and bone-graft from the opening of bone nail on treatment of lower tibial fracture in emergency.Methods 26 patients were treated by open reduction and internal fixation with interlocking bone nail and prime bone-grafting from the opening of bone nail.Results The mean time of follow-up was（15±3.6）months（range 7 months to 26 months）.All incisions healed without infection and skin necrosis.24 cases got bone union in average of（3.8±0.4）months（range 3 months to 5 months）.2 patients got delayed union.According to Tenny-Wiss rating score system,21 cases were excellent,3 good and 2 fair.Conclusions Open reduction and internal fixation with interlocking bone nail and bone-graft from the portal is effective for distal tibial fracture with high rate union and less complication,which can raise the rate of bone union of lower tibial fracture and avoid the operation of delayed bone-gafting and the complication from bone-gafting from flank bone.