交锁髓内钉在严重多发伤早期的应用

Early Application of Interlocking Intramedullary Nail in Treating Severe Multiple Trauma

目的在伴有下肢长骨骨折的严重多发伤中Ⅰ期应用交锁髓内钉与损伤控制骨科（dam age con tro l ortho-ped ics,DCO）经典外固定架比较,探讨交锁髓内钉在严重多发伤救治中的应用。方法对2005年8月至2010年4月符合条件的24例伴有下肢长骨骨折的严重多发伤患者予以分组对照研究,按术式选择分为交锁髓内钉固定组和DCO外固定组。比较两组术中、术后损伤控制情况、术后并发症及骨折愈合情况。结果虽然髓内钉组术中出血量多,手术时间长,但在损伤控制范围内。两组术中及术后监测指标、全身严重并发症发生率、死亡率无明显差异。随访6~24个月,髓内钉组局部并发症少于外固定组,其Johner-W ruhs功能评分较外固定组好,骨折愈合时间优于外固定组并有统计学差异（P〈0.05）。结论早期应用交锁髓内钉治疗伴有下肢长骨骨折的严重多发伤可获得与经典DCO外固定架相近的损伤控制效果,且在骨折愈合方面有优势,交锁髓内钉在严重多发伤早期救治中有良好的应用价值。

Objective To investigate the application value of Interlocking Intramedullary Nail in treating severe multiple trauma accompanied with long bone fracture of lower limber by comparing with classical external fixators in stage Ⅰ.Methods A retrospective control analysis was done on 24 cases with severe multiple trauma accompanied with long bone fracture of lower limber from august 2005 to april 2010.All cases were randomly divided into two groups according to different operation methods,ie,Interlocking Intramedullary Nail group（Group A） and external fixators group（Group B）.The damage controlling during operation,the general situation after operation and local outcomes were compared between two groups.Results Interlocking Intramedullary Nail cases had better results in bone union and function outcome evaluated by Johner-Wruhs score and partial illness complication than classical external fixation cases although their had much more operation time and blood loss.There were no statistically significant differences in monitoring index,incidence of serious complication,mortality between two groups.The follow-up time was 6~24 months.Conclusion Similar damage control level can be achieved by interlocking intramedullary nail in comparison with classical external fixator in treating severe multiple trauma with long bone fracture of lower limber,for interlocking intramedullary nail can bring excellent bone union and will have favorable prospect in early treating severe multiple trauma.