交锁钉与外固定架治疗胫骨干多段骨折的疗效比较

目的　评价交锁髓内钉和单臂外固定架对胫骨干多段骨折的治疗效果。方法　回顾分析 1998年以来治疗胫骨干多段骨折应用交锁钉3 8例 ,应用外固定架 3 0例 ,比较术后 2年的恢复情况。结果　交锁钉治疗组骨折原位愈合率为 92 %( 3 5 /3 8) ,成角畸形愈合率 2 6%( 1/3 8) ,骨折延迟愈合 5 3 %( 2 /3 8) ,骨不连 0例 ,骨髓炎 2 6%( 1/3 8) ,皮瓣坏死 2 6%( 1/3 8) ,大隐静脉损伤 5 3 %( 2 /3 8) ,筋膜间隙综合征 0例。平均骨折愈合时间 6.5个月。而外固定架组分别为 5 0 %( 15 /3 0 )、16.7%( 5 /3 0 )、2 6.7%( 8/3 0 )、6 7%( 2 /3 0 )、10 %( 3 /3 0 )、10 %( 3 /3 0 )、10 %( 3 /3 0 )、6 7%( 2 /3 0 ) ,针眼感染 16 7%( 5 /3 0 ) ,平均愈合时间 8.5个月。结论　交锁髓内钉治疗胫骨干多段骨折生物力学好、操作方便、固定牢固、对骨折局部血供损伤小 ,下床负重早 ,其治疗效果好 ,并发症少。

Analysis on Effect of Interlocking Intramedullary Nailing and Unilateral Exteral Fixation in Treating Tibial Smashing Fractures

Objective To evaluate the efficacy of interlocking intramedullary nailing and unilateral exteral fixation in the treatment of tibial smashing fractures.Methods Aretrospective analysis was done on the recovery of 38 cases with tibial smashing fractures treated with the interlocking intramedullary nailing(Group A) and 30 treated with unilateral exteral fixation(Group B) from 1998.Results The 12～24 months follow up showed that healing rate and the infection rate were 94.7%(36/38) and 5.2%(2/38) respectively in the Group A with a mean healing time 6.5 months and 76.7%(23/30) and 36.7%(11/30) respectively in the Group B with a mean healing time for 8.5 months.Conclusion The interlocking intramedullary nailing has obvious advantage of excelent biodynamics,reliable fixation,simple operation,less trauma on regional blood supply and is more effective in the treatment of tibial smashing fractures than the unilateral exteral fixation.