一期与择期带锁髓内钉治疗股骨干开放性骨折比较

Comparative analysis of immediate and selective interlocked intramedullary nailing for treatment of open femoral shaft fractures

目的 比较开放性股骨干骨折一期与择期带锁髓内钉治疗效果和并发症。方法 34例 4 1侧开放性骨折 ,分别按急诊清创后直接行带锁髓内钉固定和急诊清创缝合开放伤口择期行带锁髓内钉固定两种方法进行治疗。结果 随访半年以上 ,骨折全部愈合 ,髋、膝关节活动良好。 1例发生皮肤窦道不愈合 ,未发生进一步深部感染 ,10个月后取钉 ,皮肤窦道愈合。 2例发生下肢短缩 ,未发生髓内钉断裂 ,1例远端锁钉断裂 ,1例远端锁钉松动 ,但未影响骨折愈合及关节功能。一期髓内钉内固定组在手术总时间、住院日、住院费用、抗生素用量、部分负重时间等方面明显优于择期手术 ,而在手术后的疗效、并发症方面无显著差异。结论 感染发生的危险性不是开放性股骨干骨折带锁髓内钉治疗的禁忌症 ,彻底清创 ,条件允许可以一期行手术治疗。

Objective To compare the therapeautic effect and complication of immediate and selective interlocked intramedullary nailing treatment of open femoral shaft fractures.?Methods Forty one open femoral shaft fractures of 34 cases were treated in group A(immediate fixation with interlocked intramedullary nailing after debridement) and group B(selective fixation with interlocked intramedullary nailing after debridemen and closing the wound.?Results All cases were followed up more than half a year. All bones were united, with excellent joint fuction of hip and knee.There was one case of sinus formation but not deeply infected which healed after removal of the nail 10 months after the operation.Legs were shortened in two cases, no nail was broken except 1 distal locking screw broke and 1 distal locking loosened but bone union and joint function were not affected.The results of immediate fixation group were much better than the selective fixation group in total operation time, hospital stay and cost, the amount of antibiotics used, partial weight bearing.No difference in therapeutic effects and complications was found between two group.?Conclusion Infection was not the contra indication of interlocked intramedullary nailing in open femoral fractures.Immediate operation can be done after thorough debridement.