髓内扩张自锁钉与加拉力螺钉治疗胫骨粉碎性骨折的临床比较

Clinical Controlled Study of Single Intramedullary Expand Self-locking Nail and Additional Cannulated Screws on Treatment of Tibia Comminuted Fracture

目的对比单纯采用髓内扩张自锁钉与加拉力螺钉治疗胫骨粉碎性骨折的临床效果,并同时探讨髓内扩张自锁钉加拉力螺钉内固定术的技术要点。方法 2001年9月至2010年4月,采用切开复位自锁髓内钉内固定术治疗胫骨粉碎性骨折32例,其中单纯采用髓内扩张自锁钉治疗胫骨粉碎性骨折组15例,男9例,女6例;年龄20～53岁,平均(31.6±1 6.8)岁;骨折按AO/OTA分型,B1型2例,B2型7例,B3型2例,C1型3例,C2型1例。采用髓内扩张自锁钉加拉力螺钉治疗胫骨粉碎性骨折组17例,男11例,女6例;年龄21～52岁,平均(34.5±1 6.6)岁,B1型3例,B2型6例,B3型3例,C1型3例,C2型2例,比较两组手术时间、术中出血量、术中术后并发症、下地时间、骨折愈合时间、使用改良HSS评分来评价术后1年膝关节功能的改善程度。结果术后单纯采用髓内扩张自锁钉组随访11～18个月,平均(13.0±1.3)个月;采用髓内扩张自锁钉加拉力螺钉组随访11～18个月,平均(13.0±1.1)个月。所有病例全部愈合,膝踝关节功能正常。骨折单纯采用自锁髓内钉组及采用自锁髓内钉加拉力螺钉组手术平均时间分别为(52±19)min、(58±20)min(P>0.05);术中平均出血量分别为(83±24)mL、(85±31)mL(P>0.05);下地负重时间分别为(4.0±3.2)个月、(2.0±0.7)个月(P<0.05);骨折愈合平均时间(9.0±2.8)个月、(6.0±1.9)个月(P<0.05);术后1年膝关节HSS评分分别为平均(86±7)分、(83±10)分(P>0.05)。结论髓内扩张自锁钉加拉力螺钉治疗胫骨粉碎性骨折效果满意,具有固定坚强,下地时间早,术后愈合时间短等优点,是治疗胫骨粉碎性骨折的一种较好方法。

Objective To comparing clinical effect between single application of intramedullary expand self-lock-ing nail and additional lag screws on treatment of close comminuted fracture. Also,discussing keys of intramedullary self-locking nail with additional eannulated screws in internal fixation. Methods From September, 2001 to Apil, 2010,32 cases were applied with open reduction and intramedullary self-locking nail with lag screw to treat tibia corn minuted fracture,including 15 cases （age 31.6：k 16.8;9 men and 6 women） with single application of intramedullary expand self-locking nail and 17 cases （age, 21- 52 years;the average age, 34.5 ±16.6;11men and 6 women） with addi-tional lagscrews in internal fixation. All cases were classified by AO/OTA. In 15 cases：type B1,2 cases;type B2,7 cases ;type B3,2 cases ; type C1,3 cases ; type C2, lcases. In 17 cases ：type B1,3 cases ;type B2,6 cases ; type B3,3cases ; type C1,3 cases ;type C2,2 cases. Contrast the two teams of cases on operation time ,intraoperative bleeding volume, intraoperative and postoperative complication,walkable time,fracture healing time and postoperative knee joint func-tion improvement evaluated by amended HSS assessment in one year later. Results Postoperative clients treated with single application of intramedullary expand self-locking nail were followed up for 11-18 months （ 13.0±1.3 month） and those with additional cannulated screws in internal fixation were followed up for 11 - 18 months （13. 0±1. 1 month）. All fractures healed. Knee and ankle joint function covered. The team of 15 cases and team of 17 cases respec- tively on operation time were （52 ± 19） min, （58 ± 20） min, （P〉0.05） ;on intraoperative bleeding volume were （83 ±24） mL, （85±31） mL, （P〉0. 05）;on walkable time were（4.0±3.2） mon, （2.0±0.7） mon, （P〈0.05） ;t.he average fracture healing time were （9.0 ± 2.8） mon, （6. 0 ± 1.9） mon, （P 〈 0. 05） ; and the average postoperative knee joint function HSS assessment were 86 ± 7, 83±10, （P 〉 0. 05）. Among cases treated with single application of in tramedullary expand self-locking nail ,two took second X-ray,dicovering that the butterfly bone moved. However,the axial line of lower limb didn＇t change,so use plaster to assist fixation then the client was healed. Conclusion The effect of intramedullary expand self-locking nail with additional lag screws on treatment of tibia close comminuted fracture was satisfactory. It was a good choice with firm structure ,security,earlier walkable time ,short fracture heal ing time and many other advantages.