胫腓骨骨折内固定器材的选择与生物力学分析

Biomechanics analysis and choice of the internal fixation devices for tibia-fibular fracture

目的 :对胫腓骨骨干骨折内固定器材进行选择与分析。方法 :对 2 5 6例各类型不同部位胫腓骨骨干骨折 ,分别采用AO加压钢板 3 2例 ,Ender钉 68例 ,矩形弹性髓内钉 12 5例 ,交锁髓内钉 3 1例进行内固定治疗。结果 :经 3～ 2 4个月随访 ,本组 2 5 6例骨折愈合时间 :3个月内 3 1例 ,4～ 6个月 188例 ,6～ 8个月 3 5例 ,延期愈合与再骨折 2例 ,踝、膝关节功能正常 2 40例 ,部分受限 8例 ,负重疼痛 8例 ,内固定断裂 2例 ,内固定松动 4例。结论 :理想的内固定器材 ,应当是其力学性能与骨骼的生物力学之间的良好结合 ,这种力学的平衡应当维持整个骨折愈合的全过程。矩形弹性髓内钉和交锁髓内钉 ,基本上可以达此要求 ,因此两种内固定器材都有应用推广的价值。

Objective: To improve the treatment of tibia-fibular fracture. Methods: Two hundred and fifty-six patients with tibia-fibular fracture were treated with different internal fixation devices: 32 with AO exerted plate, 68 with Ender nailing, 125 with rectangle elastic nailing and 31 with interlocking nailing. Results: All of these cases were followed up for 3～24 months. Of all the patients, the time of fracture-union was 3 months in 31 cases, 4～6 months in 188 cases and 6～8 months in 35 cases. Delayed union and refrature occurred in 2 cases. The motion of knee and ankle joint was normal in 240 cases, partly limited in 8 cases, load suffering in 8 cases, internal fixation device broken in 2 cases and loose in 4 cases. Conclusion: The ideal choice of internal fixation devices should combine mechanics of fixture well with skeletal biomechanics, and the balance of mechanics should be in the course of fracture healing. Both rectangle elastic nailing and interlocking nailing can get the goal.