三种交锁髓内钉治疗胫骨骨折疗效比较

目的：评价静力扩髓型、动力扩髓型和动力不扩髓型三种类型的交锁髓内钉对胫骨骨折的疗效。方法：骨折类型采用AO骨折分型法，A型18例，B型32例，C型12例，共62例，均采用切开复位内固定治疗方法。结果：62例均获得随访，平均随访时间为13个月。根据胫骨干骨折治疗最终效果的评价标准评价术后功能，优46例，良11例，一般4例，差1例。结论：A型骨折三种髓内钉比较，骨折愈合时间有非常显著性差异；B型骨折三种髓内钉愈合时间比较，其中扩髓型与不扩髓型有非常显著性差异，而扩髓型中静力型与动力型间无显著性差异；C型骨折静力扩髓型与动力不扩髓型愈合时间比较，有非常显著性差异。术中宜尽量避免扩髓，并以采用不扩髓钛合金三角形交锁钉为佳。

Comparison of therapeutic effect of tibial fracture with three different methods for locked intramedullary nail

Objective:To compare the therapeutic effect of tibial fracture with different methods for locked intramedullary nail.Methods:62 cases of tibial and fibularis fracture were treated with open reduction and different internal fixation,of which effect were analyzed.Results:All the cases were followed up for an average of 13 months after operation.According to the criteria of Johner-Wruhs,therapeutic effectiveness was excellent in 46 cases,good in 11 cases,fair in 4 cases and poor in 1 case.The satisfactory rate was 91.9%.Conclusion:The difference of the union time is obviously significant in the three kinds of nails for type A fracture.For the treatment of type B fracture,the union time of EMC nails differs from that of non-EMC nails and the union time of static nails does not differ from that of dynamic nails.The difference of the union time is obviously significant between EMC static nails and non-EMC dynamic nails in the treatment of type C fracture.Enlarging medullary cavity should be avoided during the operation and it will be better to choosing titanium alloy triangular locked nail without enlarging medullary cavity.