胫腓骨多段骨折固定方式的选择

Choice of surgical methods for the treatment of multi-fragment fracture of tibia and fibula

目的分析并总结胫腓骨多段骨折的手术治疗方法和疗效。方法对2008年1月至2010年10月收治的胫腓骨多段骨折77例,分别采用交锁髓内钉、锁定加压钢板、外固定架结合有限内固定作为固定物进行治疗。结果患者均得到随访,平均随访时间为11.2月。根据Johner-Wruhs评分,髓内钉组优良率90.7%,锁定钢板组优良率93.2%,外固定架组优良率77.2%。外固定架组的优良率显著低于其它两组,且功能恢复时间显著长于其它两组(P<0.05)。结论 3种方法均适用于治疗胫腓骨多段骨折。外固定架主要适用于软组织损伤较严重或开放骨折,髓内钉适用于骨折区域集中于胫骨中段的骨折,而锁定钢板更适用于骨质疏松、骨折波及至关节面的骨折。

Objective To compare the effect of three-staged surgical treatment of multi-fragment tibia and fibula fractures. Methods Between January 2008 and October 2010,77 patients with multi-fragment fractures tibia and fibula were treated with interlocking intramedullary nailing,24 were treated with locking compression plates,25 were treated with external fixation. Results All patients were followed up for 7 ~ 16 months （ 11. 2 months in average）. Based on Johner-Wruhs scoring system,excellent and good rate was 90.7 % for interlocking intramedullary nailing,93. 2% for locking compression plates, and 77. 2% for external fixation. The results were significantly different（P〈 0. 05 ）. Conclusions To choose surgical method based on pathological types will be the key for obtaining satisfactory effect and reducing complications. Particularly,locking compression plates best suit metaphysis comminuted fracture of joint surface and osteoporosis fractures,interlocking intramedullary nailing will best suit tibia fracture, while external fixation will suit open fractures.