胫骨干骨折交锁髓内钉内固定失败的原因剖析及处理策略

目的研究胫骨干骨折交锁髓内钉内固定失败的原因以及相应处理策略。方法选择2010年5月~2015年12月本院收治的胫骨干骨折交锁髓内钉内固定失败患者11例,回顾剖析导致髓内钉内固定失败原因,探寻改进方法,制定处理方法。结果胫骨髓内钉内固定失败的主要原因有:术中大范围剥离胫骨骨折端周围软组织、胫骨平台进钉点选择错误、成角移位未纠正、髓内钉型号选择错误、螺钉固定不稳妥、远端锁钉置入位置错误、术后切口感染、骨质缺损过多、术后不正确的功能锻炼、内固定材料选择错误、内固定材料材质不合格等,经过5~13个月相应处理后,11例胫骨干骨折髓内钉内固定失败患者得到有效治疗,骨折顺利愈合,小腿功能恢复正常。结论胫骨干骨折行髓内钉内固定术治疗时一定要综合考虑患者是否出现严重软组织损伤、骨折类型与特点等因素,合理选用髓内钉固定与手术技巧,注意术后护理与康复指导锻炼,可以提高胫骨髓内钉内固定治疗成功率。

Analysis of the causes of failure of interlocking intramedullary nail internal fixation for tibial shaft fractures and treatment strategy

Objective To investigate the causes of failure of interlocking intramedullary nail internal fixation for tibial shaft fractures and treatment strategies.Methods 11 patients with interlocking intramedullary nail internal fixation for tibial shaft fractures who were admitted to our hospital from May 2010 to December 2015 were selected.The causes of failure of intramedullary nail internal fixation were retrospectively analyzed,the improvement method was explored,and treatment method was formulated.Results The main reasons for the failure of tibial intramedullary nail internal fixation were:intraoperative wide range of peeled soft tissues around the side of tibial fractures,incorrect selection of tibial plateau nail entrance point,uncorrected angular displacement,incorrect selection of intramedullary nail model,unstable nail fixation,distal locking nail placement error,postoperative incision infection,excessive bone defects,postoperative incorrect functional exercise,incorrect selection of internal fixation materials,unqualified internal fixation materials,etc. After 5 to 13 months of corresponding treatment,the treatment was effective for 11 cases of intramedullary nail fixation failure after tibial shaft fractures,the fractures were healed,and the calf function returned to normal.Conclusion In the treatment of tibial shaft fractures by intramedullary nail internal fixation,it is necessary to comprehensively consider whether the patients have serious soft tissue injury,fracture type and characteristics,and appropriately choose the intramedullary nail fixation and surgical technique.Postoperative care and rehabilitation guidance exercise can improve the success rate of internal fixation of tibial intramedullary nail.