胫骨型髓内分叉钉治疗胫骨骨折的生物力学研究

目的　对胫骨型髓内分叉钉 (TITN)内固定胫骨骨折的生物力学性能进行实验研究 ,为临床应用提供理论依据。方法　采用 36根湿尸体胫骨标本进行实验 ,比较TITN与矩形钉 ,Ender钉及梅花钉固定之胫骨骨折在抗扭转、抗弯曲和抗轴向拉伸刚度等方面差异性。结果　扭转试验、弯曲试验及轴向拉伸试验结果均表明TITN的抗扭、抗弯、抗轴向拉伸刚度均优于矩形钉、Ender钉、梅花钉 (P <0 0 5 )。结论　TITN有良好的生物力学性能 ,有较强的骨折固定作用和稳定性 ,尤其在抗旋转和抗拉性能方面     

胫骨型髓内分叉钉治疗胫骨骨折的生物力学研究

目的：对胫骨型髓内分叉钉（TITN）内固定胫骨骨折的生物力学性能进行实验研究,为临床应用提供理论依据。方法：采用36根湿尸体胫骨标本进行实验,比较TITN与矩形钉,Ender钉及梅花钉固定之胫骨骨折在抗扭转、抗弯曲和抗轴向拉伸刚度等方面差异性。结果：扭转试验、弯曲试验及轴向拉伸试验结果均表明TITN的抗扭、抗弯、抗轴向拉伸刚度均优于矩形钉、Ender钉、梅花钉（P＜0.05）。结论：TITN有良好的生物力学性能,有较强的骨折固定作用和稳定性,尤其在抗旋转和抗拉性能方面。     

半圆形动态交锁髓内钉的研制及其固定胫骨中下段骨折的临床应用

作者设计一种半圆形动态交锁髓内钉（ＳＤＬＩＮ）用于胫骨中下段骨折内固定，它是由内、外侧钉组成，两侧钉分别自内踝后份和前踝外份处打入，其中央部分相互咬合，钉尾用横栓连接，形成一整体结构。生物力学测试证实ＳＤＬＩＮ的综合力学性能明显优于动态不扩髓腔胫骨钉（ＤＵＴＮ）、Ｅｎｄｅｒ钉、矩钉。１９９４年１０月～１９９６年２月共治疗３０例胫骨中下段不稳定骨折，术中不需扩髓腔及Ｃ臂Ｘ光机引导，术后不需外固定。２９例获随访３～１９个月，骨折全部愈合。骨折平均愈合时间：闭合性骨折为２．８个月（新鲜）和４．７个月（陈旧性）；开放性骨折３．７个月。按ＪｏｈｎｅｒａｎｄＷｒｕｈ疗效标准，总的优良率９６．６％（闭合性骨折１００％，开放性骨折９２．３％）；无弯、断、退钉及拔钉后再骨折等并发症。初步认为：ＳＤＬＩＮ是一种适用于各型胫骨中下段骨折的较优良的内固定器械。     

交锁髓内钉固定治疗胫骨骨折

目的探讨交锁髓内钉治疗胫骨骨折治疗效果及经验。方法对48例胫骨骨折采用交锁髓内钉内固定治疗，其中闭合性骨折31例，开放性17例，闭合性骨折均行小切口切开复位。48例平均随访6个月(6～24个月)。结果根据Johner—wruh评分标准，优39例，良7例，差2例。优良率95．8％。交锁髓内钉治疗胫骨骨折创伤小，固定可靠，并发症少，是一种理想的方法。     

梅花型髓内钉内固定治疗胫骨干骨折

梅花型髓内钉内固定治疗胫骨干骨折陆才方，李永盛，李传满自１９９０年以来采用梅花型髓内钉内固定治疗胫骨干骨折２８例，经随访效果满意，现总结报告如下。１临床资料１．１一般资料本组２８例，男２０例，女８例。年龄１７岁～６０岁，平均３８岁。闭合性骨折２０例，...     

胫骨骨折--髓内钉与石膏固定治疗的比较

许多研究表明,对于闭合性或I度开放性胫骨骨折,髓内钉的治疗效果可能比石膏固定治疗效果要好。在髓内钉治疗组中,骨折愈合时间和返回工作岗位时间较短,且骨折延迟愈合和不愈合的情况要更少。与石膏固定治疗组相比,髓内钉治疗组疼痛更强烈些,虽然患者对疼痛的抱怨较多,然而一些与健康相关生活质量方面的治疗结果仍然比石膏固定治疗组优秀。     

带锁髓内钉固定治疗胫骨骨折

目的:分析总结带锁髓内钉固定治疗胫骨骨折的疗效。方法:作者回顾了53例胫骨骨折,均采用带锁髓内钉固定治疗,其中闭合骨折39例,开放骨折14例。53例骨折5～38个月回访。疗效评定采用Johner-wruh评分标准。结果:在39例闭合骨折中,最终结果优33例,良5例,中1例,在14例开放骨折中,优10例,良3例,中1例。53例病人手术后均无继发性骨筋膜室综合征、神经损伤、钉体断裂等情况发生。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。     

胫骨旋入式自锁髓内钉固定治疗胫腓骨骨折

2002年4月至2004年5月,我科收治胫腓骨骨折49例,其中采用胫骨旋入式自锁髓内钉固定15例,取得满意效果,现报告如下。1临床资料1.1一般资料本组15例,男13例,女2例;年龄24~65岁,平均32岁。交通事故伤10例,坠落伤3例,跌伤2例。骨折部位:上1/3段4例,中1/3段8例,下1/3段3例。闭合性骨     

胫骨应解剖与胫骨型髓内分叉钉设计

目的通过胫骨应用解剖测量,为胫骨型髓内分叉钉(TITN)设计提供解剖依据.方法采用成人湿胫骨30及干燥胫骨20根,进行胫骨相关解剖测量;用10套TITN固定胫骨干骨折,摄正侧位X片,观察骨折复位及内固定情况.结果胫骨下松质区长度8.12cm,胫骨下端宽4.18cm,胫骨下端矢状径3.65cm,胫骨结节上缘距上关节面距离2.08cm,胫骨髓腔最狭部矢状径为1.25cm,胫骨结节上方骨斜面倾斜角度为21.o.;TITN固定胫骨骨折,操作简便,骨折解剖复位,其远端分叉状结构与胫骨下端漏斗状髓腔良好相容.结论TITN设计符合并充分利用胫骨解剖特点,可用于胫骨骨折髓内固定.     

Locked intramedullary nailing of open tibial fractures

We report the use of Grosse-Kempf reamed intramedullary nailing in the treatment of 41 Gustilo type II and III open tibial fractures. The union times and infection rates were similar to those previously reported for similar fractures treated by external skeletal fixation, but the incidence of malunion was less and fewer required bone grafting. The role of exchange nailing is discussed and a treatment protocol is presented for the management of delayed union and nonunion.     

Interlocking intramedullary nailing in distal tibial fractures

This retrospective study examined the results of non-pilon fractures of the distal part of the tibia treated with interlocking intramedullary nailing. Seventy-three patients with equal numbers of fractures treated surgically between 1990 and 1998 were reviewed. Mean patient age was 39.8 years, and follow-up averaged 34.2 months. The AO fracture classification system was used. Concomitant fractures of the lateral malleolus were fixed. All but three fractures achieved union within 4.2 months on average. Satisfactory or excellent results were obtained in 86.3% of patients. These results indicate interlocking intramedullary nailing is a reliable method of treatment for these fractures and is characterized by high rates of union and a low incidence of complications.     

Unreamed intramedullary nailing in distal tibial fractures

Purpose

Unreamed nailing has gained acceptance in the treatment of diaphyseal long bone fractures, especially in cases with polytrauma or high-energy injuries. Its application in distal tibial fractures, however, remains controversial.

Methods

In this study, 101 distal tibial fractures treated using closed unreamed nailing were reviewed after a mean follow-up of 32 months. There were 59 type A und 42 type B fractures. The most common fracture pattern was the A1 spiral fracture (n = 40) followed by the B2 wedge fracture (n = 18). Intra-articular extension was encountered in 14 cases. One-fourth of the patients (n = 24) had open injuries. Forty-seven patients had additional injuries, and nearly one-third of them were polytraumatised.

Results

Union occurred after a mean time of 23.9 (range, 11–134) weeks. There were 13 cases of delayed union and seven non-unions; all healed eventually with additional surgery in only six fractures. Malunion was seen in 12 cases (five valgus, two varus and five external torsion), ten of which were associated with unplated fibular fractures. Three fractures (two open) were treated for deep infection. The most common complication seen was fatigue failure of the locking screws (27 cases).

Conclusions

Unreamed nailing of distal tibial fractures is associated with a rather high rate of bone healing complications and locking screw failure. The decision for its use in the notoriously challenging fractures of this segment should be critically considered.     

Locked intramedullary nailing for displaced tibial shaft fractures

We analysed the results of 93 tibial shaft fractures treated with the Grosse-Kempf locked nail. Twenty-six fractures were comminuted, 19 were open grade I to II, and 54 were located outside the middle third of the tibia. The deep infection rate was 3.2%. There were only two poor results. The use of this method is recommended and discussed.     

Unreamed intramedullary locking nailing for open tibial fractures

Summary. We reviewed the results of the treatment of 24 cases of open tibial fractures using unreamed intramedullary locking nailing. The fractures were classified, following the Gustilo system as grade I-7, grade II-7 and grade III-10. The average time to achieve bony union was 22 weeks with a 26% incidence of pseudoarthrosis. There were no cases of deep infection. Five cases healed with shortening of over 1 cm, but we did not observe angular deformity in any of the patients. In 2 fractures with associated articular lesions, joint motion was limited at final follow up. The nail broke in 2 cases and the screws in 5. The surgical procedure is well tolerated by patients, allows good management of soft tissue lesions and rehabilitation with low rate of infection and malunion. The main disadvantages have been the relative high incidence of nonunion and breakage of metal.

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Résumé. Les auteurs rapportent les résultats du traitement de vingt-quatre fractures ouvertes de la jambe stabilisées avec un enclouage verrouillé sans alésage. On a classifié les fractures en suivant le systeme de Gustilo: 7 grade I, 7 grade II et 10 grade III. La moyenne de consolidation fut de 22 semaines avec un pourcentage de pseudarthroses de 26%. Il n’y a pas eu d’infection profonde. Cinq cas ont consolidé avec un raccourcissement de plus d’un cm mais on n’a pas observé d’angulation. On a noté une limitation de la mobilité articulaire chez deux patients qui avaient des lésions articulaires. On a eu deux ruptures du clou et cinq de vis. Nous concluons que cette technique chirurgicale est bien tolerée par la patient, elle permet un bon maniement des tissus nous, une réhabilitation précoce et elle a un pourcentage bas d’infection ou mauvaise consolidation. Le principal désavantage a été la relative incidence de pseudarthroses et de ruptures du matériel par stabilité insuffisante.

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Accepted: 10 October 1997