三种固定方法治疗胫骨干骨折的疗效比较

目的 :对比研究三种固定方法治疗胫骨干骨折的疗效。　方法 :分别采用普通钢板、外固定支架、交锁髓内钉治疗胫骨干骨折 134例 ,并进行临床随访和分析 ,动态观察骨折的愈合过程。　结果 :骨痂出现时间 :普通钢板组 7.2周 ,交锁髓内钉组 8.1周 ,外固定支架组 5 .8周 ;骨折平均愈合时间 :普通钢板组 17.1周 ,交锁髓内钉组15 .3周 ,外固定支架组 14 .8周 ;术后并发症发生率 :普通钢板组 18例 ,占 5 0 % ;交锁髓内钉组 7例 ,占 13.7% ;外固定支架组 6例 ,占 12 .8%。对于胫骨中段及中下段骨折 ,交锁髓内钉固定或外固定支架固定可明显缩短骨折愈合时间 (P <0 .0 5 )。　结论 :三种固定方法治疗胫骨上段骨折 ,其愈合时间并无明显差异 ,采用交锁髓内钉时 ,有发生骨折畸形愈合的可能。对于胫骨中下段骨折 ,该中心推荐使用对骨断端血供影响较小的外固定支架或不扩髓的交锁髓内钉固定。

Comparison of treatment of tibial shaft fractures with different fixator

Objective:To compare the effects of 3 kinds of fixator on healing of tibial shaft fractures. Methods:134 cases of closed tibial shaft fractures were treated with plates, external fixation frame and interlocking intramedullary nailing respectively. All of them were followed-up and analyzed. Results:The emergence time of bony callus is 7.2 weeks, 8.1 weeks or 5.8 weeks respectively; the mean union time is 17.1 weeks, 15.3 weeks or 14.8 weeks respectively and the rate of complication is 50%, 13.7% or 12.8% according to different fixation device. For middle and distal tibial fractures, the union time is shorter significantly when fixated by external fixation frames or interlocking intramedullary nailings than by plates (P<0.05). Conclusion:Three kinds of fixator have similar union time for proximal tibial fracture, but there are more malunions in intramedullary nailings groups. External fixation frame and unreamed interlocking intramedullary nailing are recommended for the treatment of middle and distal tibial shaft fractures because of its less influence on the tibial blood supply.