锥状点式接触钢板固定治疗胫骨干骨折

Steel Plate Fixed by Awl-shaped Nails with Point-mode Contact for Fracture of Shaft of the Tibia

目的自行研制锥状点式接触钢板，并临床观察对胫骨干骨折固定的稳定性和对骨愈合及功能康复的影响。方法在钢板的下面两侧对称设置长３．５ｍｍ圆锥体，连接钢板的一段长２ｍｍ，直径４ｍｍ，前段端尖锐，其基部直径２ｍｍ。术中不剥离骨膜，在螺钉的轴向力作用下，使长１．５ｍｍ锥形尖端钉入骨内形成锥状点式固定。术后不加用外固定。结果本组２１例各种类型胫骨干骨折保留钢板与骨面间约２ｍｍ间隙，避免了骨膜压迫，固定牢稳可靠，术后即可进行关节功能活动，４～６周可部分负重行走。骨折愈合平均为３个月。新骨主要在骨折间隙形成，无明显外骨痂。无一例发生骨折再移位或轴线偏离、钢板变形或退钉。结论锥状点式接触钢板固定牢稳，具有保护骨膜血供及骨折愈合快的突出优点。

Objective To study the stability and the effect of a steel plate fixed by awl-shaped nails with point-mode contact made by the anthors on fracture healing and function recovery. Methods Conicalnesses for 3.5 mm high were installed symmetrically under the steel plate. The section of the conicalnesses, which contact the steel plate, was 2 mm long with diameter of 4 mm, and the front part was sharp with diameter of 2 mm. The periosteum was not stripped off during the operation. Under the axial force of the screws, the nibs of the conicalnesses were nailed into the bone for 1.5mm depth to form the awl-shaped point-mode fixation. No external fixation was employed after operation. Results The gap for 2 mm wide between the surface of bone and the steel plate could avoid periosteum constriction. This fixation was firm. The patients could perform joint functional activities postoperatively, and some could walk loadedly at 4 to 6 weeks postoperation. The average healing time was 3 months. The new bone formed mainly in the fracture gap with no obvious external callus. There was no fracture aversion; axis drift, steel plate distortion or nail drawing back. Conclusions This steel plate fixes fractures firmly, protects the blood supply in periosteum, and makes the fracture healing quicker.