辅助钢板结合扩髓交锁髓内钉治疗胫骨中上段多段骨折

Assisting plate with reamed intramedullary nailing for segmental fractures of proximal-middle tibia

目的：评价辅助钢板结合扩髓交锁髓内钉治疗胫骨中上段多段骨折的安全性与有效性.方法：2007年6月至2011年10月,共收治31例胫骨中上段多段骨折的患者,男18例,女13例,平均年龄45.2岁（23~77岁）,9例为Gustilo Ⅰ型开放性骨折,其余22例为闭合性骨折.所有患者先以辅助钢板将胫骨最近端的两个骨折块复位固定,再以扩髓交锁髓内钉对多段骨折进行整体固定.手术时机平均为伤后35.2 h（16~72 h）.术后通过临床检查、影像学评估、Johner-Wruhs评分对临床结果进行评估,并记录相关并发症.结果：所有患者术后均获随访,平均18.5个月（17~24个月）.随访期间未见伤口感染、骨筋膜室综合征等软组织并发症.X线摄片示骨折平均愈合时间为5.1个月（4~6个月）.所有患者的近、远端骨折线均同期愈合,无畸形愈合.末次随访时患者平均膝关节活动度为9°-0°-127°,按照Johner-Wruhs评分评定疗效：优19例,良10例,可2例,优良率93.5%.结论：辅助钢板结合扩髓交锁髓内钉的方法可以分解多段骨折复位固定的过程,降低手术难度,提高复位质量和固定强度,是治疗胫骨中上段多段骨折安全、有效的方法之一.

Objective：To evaluate the efficacy and safety of combining reduction plating with reamed intramedullary nailing for segmental fractures of proximal-middle tibia. Methods： From June 2007 to Oc- tober 2011, 31 patients with segmental fractures of proximal-middle tibia were admitted. There were 18 males and 13 females, with an average age of 45.2 years （range： 23 -77 years）, of whom, 9 were Gustilo I type open fractures and 22 were close fractures. All the patients were treated with assisting plate combined with reamed intramedullary nailing. The operation was performed averagely 35 h （range： 16- 72 h） after injury. During the post-operation follow-up radiographic evaluation, the range of knee joint, and Johner-Wruhs scores were measured. Results： All the patients were followed-up for 18.5 months （range： 17 -24 months）. No wound infection or osteofascial compartment syndrome happened. All the fractures healed after 5.1 months （range： 4 -6 months）. The proximal and distal fracture sites healed simultaneously. No malunion was found. In the last follow-up, the mean range of knee joint was 9°-0°-127°, and according to Johner-Wruhs scores, 19 were excellent, 10 good, and 2 fair. Conclusion： Assisting plate with reamed intramedullary nailing is a safe and effective alternative choice for segmental fractures of proximal-middle tibia, which can ease the difficulty of the procedure, improve the quantity of reduction and enhance the stability of the hardware.