非扩髓型胫骨内锁髓内钉临床应用初步报告

作者在胫骨解剖测量的基础上设计出非扩髓型骨内锁髓内打，临床应用１０例取得了满意的初步效果，作者认为非扩髓型内锁髓内钉手术不需开放，方法简单，骨折固定后抗旋转能力强，病人可早期地活动，减少卧床时间，关节功能影响小，非扩髓型胫骨骨髓内钉不需扩髓，对髓内的血供影响小，可应用于Ⅰ，Ⅱ型开放性骨折，并对其手术时机，适应证以及在开放性骨折和节段骨折的应用等方面时行了讨论。     

不扩髓带锁髓内钉治疗胫骨开放性骨折

目的总结胫骨开放性骨折应用不扩髓带锁髓内钉内固定治疗的经验及体会。方法对52例胫骨开放性骨折行清创复位不扩髓带锁髓内钉内固定。结果50例患者取得随访半年以上,骨折全部愈合,膝踝关节功能完全恢复正常。结论不扩髓带锁髓内钉内固定治疗胫骨开放性骨折固定坚强,操作简单,并发症少,功能恢复良好,疗效确切,结果令人满意。     

不扩髓交锁髓内钉治疗胫骨开放性骨折

目的 :评估不扩髓交锁髓内钉治疗胫骨开放性骨折的疗效。方法 :应用不扩髓交锁髓内钉治疗胫骨开放性骨折 46例 ,CustiloⅠ型 15例 ,CustiloⅡ型 17型 ,CustiloⅢA型 7例 ,CustiloⅢB型 5例。结果 :平均随访 17.1个月 ,平均愈合时间 2 5周 ,采用Joher Wruh评分 :优 3 0例、良 13例、中 1例、差 2例 ;无主钉弯、断、旋 ,锁钉脱出现象 ,感染 2例 ,骨折全部愈合。结论 :不扩髓交锁髓内钉在治疗胫骨开放性骨折中具有创伤小、固定坚强、感染率低、骨折愈合率高等优点 ,只要掌握好适应证及手术时机 ,是治疗胫骨开放性骨折的较好方法。     

交锁髓内钉治疗胫骨骨折的临床体会

目的 探讨交锁髓内钉治疗胫骨肌折的临床应用。方法 ４２例胫骨骨折均采用小切口切开复位、交锁髓内钉内固定治疗。新鲜骨折不扩髓,陈旧性骨折采用扩髓方法。结果 全部病例均获随访,平均随访１年１个月,骨折均愈合。术中损伤大隐静脉１例,术后关节疼痛７例。结论 应用交锁髓内钉治疗肥骨骨折需掌握好适应证,并进行良好的复位。     

胫骨带锁髓内钉治疗骨折与锁钉装置的改进

目的：探讨应用带锁髓内钉治疗胫腌骨骨折，在不需X线引导下进行手术的可行性和效果。方法：应用非扩髓带锁骨内钉治疗胫骨骨折46例。其中闭合性骨折25例，开放性骨折21例。改进带锁髓内钉远端瞄准器，增设辅助定位装置。结果：全部病例经随访6个月以上，除1例骨折术后10个月愈合外，45例骨折愈合时间平均4．8个月。患者膝、踝关节功能均恢复正常。改进后的带锁髓内钉远端瞄准器，一次钻孔交锁成功45例，无锁钉放置失败，术后无髓内钉或锁钉断裂。结论：非扩髓带锁髓内钉治疗胫腓骨骨折，手术不需X线引导，改进后的带锁髓内钉远端瞄准器，锁钉准确，简便实用。     

胫骨骨折的交锁髓内钉治疗

目的：观察交锁髓内钉在胫骨骨折中的治疗效果。方法：1997年2月－2000年2月对37例胫骨骨折采用交锁髓内钉治疗,男30例,女7例,年龄18－65岁,闭合性骨折28例,开放性骨折6例,陈旧性骨折2例,胫骨骨不连2例,开放性骨折采用非扩髓髓内钉,闭合性骨折采用扩髓髓内钉。结果：37例得到随访,骨折全部愈合,无锁钉及髓内钉松动、断裂,膝踝关节功能正常,迟发性感染1例。结论：交锁髓内钉在治疗胫骨骨折中具有创伤小、固定坚强、骨折愈合率高、能早期活动、感染率低等优点,是一种较好的内固定方法。     

带锁髓内钉治疗粉碎性胫骨骨折28例体会

目的 回顾性分析带锁髓内钉治疗粉碎性胫骨骨折的疗效。方法 带锁髓内钉治疗粉碎性胫骨骨折28例，其中闭合性骨折18例，开放性骨折10例。闭合性骨折术中均扩髓，开放性骨折均不扩髓，全部骨折采用静力性固定。结果 18例闭合性骨折平均愈合时间15．8周，10例开放性骨折平均愈合时间21．2周。结论 带锁髓内钉治疗粉碎性胫骨骨折采用闭合复位和早期静力性固定，既有利于骨折的早期愈合和患早期的床上功能锻炼，同时也具有手术操作方便，闭合复位保留血供和减少并发症等优点．     

复杂开放性胫骨骨折的治疗

目的　探讨复杂开放性胫骨骨折的治疗方法以提高其临床疗效。方法　将 5 0例Ⅲ度开放胫骨骨折按Gustilo分类法分成3型 ;其中ⅢA 型 2 5例 ,ⅢB 型 15例 ,ⅢC 型 10例。分别行跟骨牵引并夹板外固定 ,外固定支架固定 ,手术切开不扩髓交锁髓内钉内固定。采用Johner-wrhn评分标准评估治疗结果。结果　本组优良率为 6 8% (34/ 5 0 ) ,跟骨牵引并夹板优良率为2 5 % ,外固定支架优良率为 5 3 84 % ,手术切开复位。不扩髓交锁髓内钉固定组优良率最高。不扩髓交锁髓内钉Ⅰ期无张力闭合伤口病人伤口感染率无明显差异 ,Ⅰ期闭合伤口感染率低于Ⅱ期。结论　对复杂胫骨开放性骨折病人 ,应视其全身情况及局部软组织条件选择治疗方法 ,手术复位不扩髓交锁髓内钉固定同时Ⅰ期无张力闭合伤口疗效最佳     

UTN与外固定架治疗胫骨开放骨折的疗效评估

目的　比较非扩髓胫骨带锁髓内钉 (UTN)和外固定架治疗胫骨开放骨折的疗效。方法　对 72例胫骨带锁髓内钉或外固定架治疗的胫骨开放骨折进行回顾性研究 ,比较其愈合时间、感染率和畸形愈合率 ,其对伤口及软组织处理原则相同 ,病人特征和损伤分类没有统计学意义。结果　平均愈合时间 ,髓内钉组 5 2个月 ,外固定架组 7 6个月 ;畸形愈合率外固定架组高于髓内钉组 2 5倍 :感染率没有差别。结论　对于大多数胫骨开放性骨折非扩髓胫骨带锁髓内钉的疗效优于外固定架。     

复杂开放性胫骨骨折的治疗

目的 探讨复杂开放性胫骨骨折的治疗方法以提高其临床疗效。方法 将50例Ⅲ度开放胫骨骨折按Gustilo分类法分成3型；其中ⅢA型25例，ⅢB型15例，ⅢC型10例。分别行跟骨牵引并夹板外固定，外固定支架固定，手术切开不扩髓交锁髓内钉内固定。采用Johner—wrhn评分标准评估治疗结果。结果 本组优良率为68％(34／50)，跟骨牵引并夹板优良率为25％，外固定支架优良率为53．84％，手术切开复位。不扩髓交锁髓内钉固定组优良率最高。不扩髓交锁髓内钉I期无张力闭合伤口病人伤口感染率无明显差异，I期闭合伤口感染率低于Ⅱ期。结论 对复杂胫骨开放性骨折病人，应视其全身情况及局部软组织条件选择治疗方法，手术复位不扩髓交锁髓内钉固定同时I期无张力闭合伤口疗效最佳。     

S1otted锁式髓内钉治疗胫骨开放性骨折

作者应用Ｓ１ｏｔｅｄ锁式髓内钉治疗胫骨开放性骨折６４例,其中粉碎性骨折４７例。除２例失访,其余６２例骨折平均随访１．５年,骨折全部愈合。最终结果评分采用Ｊｏｈｎｅｒ－Ｗｒｕｈ评分标准,优６１例,良１例。６１例骨折平均愈合时间为５．６个月,１例延迟愈合（于术后１２个月愈合）,术后晚期发生胫前浅表感染１例,未影响骨折愈合。所有病例未发现髓内钉断裂和锁钉断裂、脱出及拨钉后再骨折等情况。作者认为Ｓ１ｏｔｅｄ髓内钉可用于胫骨干的各段骨析（包括高位和低位骨折）,对粉碎性骨折效果良好,且操作简单,不需特殊设备及器械,固定后能较好控制旋转,促进骨折愈合,是一种比较好的内固定方法。     

Intramedullary nailing without interlocking screws for femoral and tibial shaft fractures

Background

Intramedullary fixation is the treatment of choice for diaphyseal fractures of the femur and tibia. Locking the implant can sometimes be cumbersome and time consuming. In our institution, fractures with axial and rotational stability are treated with intramedullary nailing without interlocking.

Methods

All consecutive patients presented in the University Medical Center Utrecht from October 2003 to August 2009 with acute traumatic diaphyseal fractures of the tibia or femur that were considered axial and rotational stable were included. They underwent internal fixation using intramedullary nails without interlocking. Patient records were evaluated for duration of surgery, perioperative complications, consolidation time and re-operations.

Results

Twenty-nine long bone fractures were treated in 27 patients: 20 men and 7 women, with an average age of 28.9 years (range 15.6–54.4). There were 12 femoral fractures and 17 tibial fractures. Sixteen fractures were closed and 13 were open (10 Gustilo 1, 3 Gustilo 2). The mean operating time was 43 min (range 18–68 min) for tibial fractures and 55 min (range 47–150 min) for femoral fractures. Postoperative complications occurred in six patients. Two patients (three fractures) were lost to follow-up. Healing occurred in 25 of the 26 remaining fractures (96 %) without additional interventions. One tibia was secondarily converted to a standard locked nail because of axial and rotational instability. All patients returned to their pre-injury level of activity.

Conclusion

The use of intramedullary nailing without interlocking is associated with minimal complications in selected fractures. The advantages include a short operating time and the simplicity of its application.     

带锁髓内钉治疗股骨胫骨骨折

目的：探讨带锁髓内钉有股骨,胫骨骨折的应用。方法：选用江苏省武进市生产的带有远近瞄准器的股骨,胫骨钉,治疗不同类型肌骨骨折10例,胫骨骨折8例,结果：随访8月－2年3个月,18例均骨性愈合,未出现骨折,断钉感染及膝,踝关节僵硬等并发症,结论：带锁髓内钉治疗下肢骨折治愈率高,并发症少。     

Provisional plating of Type III open tibia fractures prior to intramedullary nailing

Intramedullary nailing of tibial shaft fractures is the preferred treatment of most displaced, unstable tibial shaft fractures. In open tibia fractures, direct exposure of the fracture segments for irrigation and debridement is required prior to fracture stabilization. We propose a method of provisional stabilization using commonly available implants placed through the associated traumatic open wound prior to intramedullary nailing. This technique, particularly helpful to surgeons operating with limited assistance, employs a temporarily applied 3.5-mm dynamic compression plate or limited contact dynamic compression plate implant secured with unicortical screws, allowing reaming and intramedullary nailing of a reduced, stabilized tibia fracture.     

Elastic stable intramedullary nailing of tibial shaft fractures in children

Most pediatric tibia shaft fractures are amenable to nonoperative treatment with satisfying results, yet surgical stabilization is necessary in certain cases. The purpose of our study was to determine the effectiveness and the complications associated with elastic stable intramedullary nailing in severe pediatric tibial fractures. We retrospectively reviewed 24 tibia shaft fractures in 24 patients that were treated operatively by elastic stable intramedullary nailing between 1997 and 2005 at our institution. Extensive review of all charts and radiographic data was completed at Cincinnati Children's Hospital Medical Center. There were 8 closed and 16 open fractures. The average union time for all tibia fractures was 20.4 weeks. The average union time for closed and open fractures was 21.5 and 20.2 weeks, respectively. Complications include 2 (8%) neurovascular, 2 (8%) infections, 2 (8%) malunions, and 1 (4%) leg-length discrepancy. Although complications do exist, elastic stable intramedullary nailing of pediatric tibia shaft fractures using Nancy nails is an effective treatment option.     

闭合复位有限扩髓带锁髓内钉治疗胫骨骨折

目的探讨闭合复位、有限扩髓带锁髓内钉治疗胫骨骨折的疗效。方法应用闭合复位、有限扩髓带锁髓内钉治疗胫骨骨折73例,均静力固定。对合并有腓骨骨折的胫骨不稳定性骨折,行腓骨骨折固定。结果患者均获随访,时间6—21（13．6±3．2）个月,骨折均愈合,时间4～10（6．2±1．6）个月。功能恢复按Johner—Wruhs标准：优62例,良11例。3例出现骨折延迟愈合,无骨折畸形愈合、小腿骨筋膜室综合征、断钉等并发症。结论闭合复位、有限扩髓带锁髓内钉治疗胫骨骨折具有固定牢固、微创、加快骨折愈合,减少骨不连、断钉等优势,是治疗胫骨骨折一种较好的内固定方法。     

弹性髓内针治疗儿童长骨骨折

目的探讨弹性髓内针固定治疗儿童长骨骨折的并发症及预后。方法回顾性总结我院2004年1月至2010年5月收治的47例儿童非粉碎性长骨骨折,包括肱骨骨折、尺骨桡骨骨折、股骨骨折、胫骨骨折。47例患儿中,男性27例,女性20例;年龄6~14岁。肱骨骨折6例,尺桡骨骨折20例,股骨骨折15例,胫骨骨折6例。对于尺桡骨骨折,采用麻醉下闭合复位,单根弹性髓内针固定,石膏固定2~3周后自主活动。对于肱骨、股骨、胫骨骨折,采用麻醉下闭合复位,双根弹性髓内针交叉固定。肱骨骨折后石膏固定3周后自主活动;股骨、胫骨骨折石膏固定5~6周,8~10周后完全负重行走。结果 47例患儿经弹性髓内针内固定治疗后,骨痂生长良好,均获治愈,并且关节功能恢复正常,无严重的并发症。结论术前合理选择患儿年龄、骨折类型,采用弹性髓内针治疗儿童长骨骨折,具有微创、安全、简便、复位好、恢复快和并发症少的优势。     

Open grade III fractures of tibia: outcome after early unreamed intramedullary nailing

Open grade III fractures of tibia are challenging therapeutic problem even to experienced surgeons. Method for skeletal stabilization of these fractures remained a topic of controversy. One hundred and two patients with 103 open grade III fractures of tibia were included in the study. They were treated with early unreamed intramedullary nailing with the adequate management of soft tissue. Patients were reviewed retrospectively. Mean time of union was 35 weeks. Six tibial fractures had nonunion. Infection rate was 14% in open grade III tibial fractures. No case of angular or rotational deformity was noted. In conclusion, early unreamed intramedullary nailing for open grade III fractures of tibia after giving due respect to the soft tissue injury gives good outcome with proper alignment, good range of motion, short rehabilitation period and low infection rate.     

带瞄准装置的交锁髓内针在下肢骨折中的应用(附76例报告)

目的 总结使用带锁髓内针治疗股骨、胫骨骨折的临床经验。方法 回顾性分析从1998年6月～2001年1月所做带锁髓内针治疗股骨和胫骨骨折的病人76例，其中股骨30例，胫骨46例，均为闭合性骨折。术中股骨均采用开放复位，胫骨闭合复位26例，开放复位20例，未使用C型臂X光机透视：术后病人即刻行邻近关节功能活动锻炼。结果 30例胶骨干骨折3个月内临床骨愈合；46例胫骨骨折6个月临床愈合。胫骨、股骨病人中有30例远端锁钉未能锁上，无断钉断针及感染发生全部病人术后关节功能恢复达正常的90％～100％。结论 操作简单，不需电视X光机透视，易于推广。内固定稳定可靠，抗疲劳度好，能早期行功能锻炼，最大限度的恢复肢体功能。     

带锁髓内钉治疗胫骨骨折(附76例报告)

目的 总结带锁髓内钉治疗胫骨骨折的经验。方法 采用带锁髓内钉内固定的不同类型的胫骨骨折76例。其中闭合骨折55例，开放骨折21例。76例平均随访时间17．9个月(4～31个月)。疗效评定采用Johner-wruh评分标准。结果 在55例闭合骨折中，优49例，良5例，中1例；21例开放骨折，优17例，良3例。差1例。术后均无继发性骨筋膜室综合征，无神经损伤、钉体断裂和感染。结论 带锁髓内钉适用于治疗胫骨骨折，非扩髓带锁髓内钉适于开放骨折和多发伤；早期手术并不影响预后。且可减少并发症。