多功能胫骨带锁髓内钉治疗胫骨近端关节外骨折疗效观察

Efficacy of the tibial intramedullary nail with multifunctional interlocking in treating extraarticular proximal tibial fractures

目的探讨应用多功能胫骨带锁髓内钉(TINMI)治疗胫骨近端关节外骨折的疗效。方法回顾性分析对21例胫骨近端关节外骨折患者采用TINMI治疗。结果手术时间60～120 min,平均80 min。失血量50～200mL,平均100 mL。术后均随访11～24个月,平均17.5个月;骨折均愈合,愈合时间11～16周,平均13周,其中18例对线良好、1例有>5°外翻成角、2例有>5°向前成角。完全负重时间11～18周,平均16.2周。膝关节活动范围为100°～120°,均无感染、断钉、固定失效等并发症。按照Johner-Wruhs评分,疗效为优13例,良5例,中3例,差0例,优良率85.7%。结论 TINMI结合一些手术技巧可有效治疗胫骨近端关节外骨折,且创伤小、手术时间短、并发症少、骨折愈合率高。

Objective To observe the efficacy of the tibial intramedullary nail with multifunctional interlocking（TINMI） in treating extraarticular proximal tibial fractures.Methods A retrospective analysis was conducted in 21 cases of extraarticular proximal tibial fractures treated with TINMI.Results All the cases were followed up for 11-24 months（an average of 17.5 months）.The mean operation time was 80 minutes（60-120 minutes）.The average blood loss was 100 mL（50-200 mL）.All fractures healed,the average healing time was 13 weeks（11-16 weeks）.The postoperative alignment in 18 fractures was satisfactory,1 case with 5° valgus angulation,2 cases with 5° anterior angulation.The mean time of full weight bearing was 16.2 weeks（11-18 weeks）.The range of movement was 100°-120°.All the cases had no infection,breakage of screws,failed fixation and so on.According to Johner-Wruhs scores system,there were 13 excellent cases,5 good cases,3 fair cases,0 poor case,the excellent and good rate was 85.7%.Conclusions TINMI combined with some surgical skills is an effective way in treating extraarticular proximal tibial fractures,and it has the advantage of less trauma,shorter operative time,fewer complications,high rate of fracture healing.Grasping the procedure and adjustment according to the specific cases are very important to assure satisfactory results.