内踝入路非扩髓动力髓内固定治疗胫骨下段骨折的前瞻性研究

Exit Point of Medial Malleolus for Tibial Fractures of Low Part with Intramedullary Nailing: A Prospective Study

目的:探索胫骨下段骨折髓内固定的新方法。方法:1998年～2001年间,随机选择25例胫骨下段骨折,年龄17岁～54岁,平均30.84岁;男23例,女2例。16例闭合骨折,0级5例、1级7例、2级4例;9例开放骨折,1级7例、2级2例。骨折复杂程度,A型4例、B型19例、C型2例。平均连续随访13个月,观察早期负重、骨连接愈合时间、关节功能及骨不连、延迟愈合、感染等。结果:全部病例采用内踝入路非扩髓逆行动力预弯梅花针髓内固定。平均术后7.5天(3天～21天)早期负重。平均19.04周(10周～40周)骨连接愈合。创伤与非创伤肢体膝关节活动度无统计学差别,但踝关节存在差别。无骨不连、畸形愈合。1例延迟愈合,在鼓励负重下于40周骨连接愈合。1例开放2级C型骨折,伤口软组织感染,保留髓内固定、清创换药、静脉与局部抗生素应用及植皮治愈。结论:胫骨下段骨折内踝入路非扩髓动力髓内固定是一值得临床探讨的新方法。

Objective: To explore the new technique of the exit point of medial malleolus for tibial fractures of low part with intramedullary nailing. Methods: Twenty-five patients with tibial fractures in the low part were treated by intramedullary nailing with the exit point of medial malleolus from 1998 to 2001. There were 16 cases of close fractures, 5 case type 0, 7 cases type 1 and 4 cases type 2 (Oestern). There were 9 cases of open fractures, 7 case type 1 and 2 cases type 2 (Gustilo). There were 4 case type A fractures, 19 case type B and 2 cases type C (Muller). Our patients were 23 males and 2 females; their mean age was 30.84 years (range 17 to 54). All patients were retrospectively followed with a mean of 8 months (range, 3-13 months) with investigate earlier weight-bearing, bone healing, early functional recovery, and nonunion, delayed union, infections, malunion. Results: All patients were early weight-bearing at an average of 7.5 days (range 3-21 days), and the mean time to union was 19.04 weeks (rang 10-40weeks). Although there wasn't a significant difference in the angle of knee motion between uninjured limb and injured limb, there was a significant difference in the angle of ankle motion between uninjured limb and injured limb. There weren't nonunion and malunion in our patients. There was one cases (4%) of delayed union, next be healed by encouraging weight-bearing at 40 weeks. Superficial wound infection occurred in one patient (4%) with open fracture (type 2, C); he were treated successfully using appropriate systemic antibiotics, wound debridement and skin grafting. Conclusion: It might be a new method of potential value to treat tibial fractures of low part with the technique of the exit point of medial malleolus with intramedullary nailing.