扩髓与非扩髓带锁髓内钉治疗开放性胫骨骨折的疗效比较

目的　比较扩髓与非扩髓带锁髓内钉治疗开放性胫骨骨折的临床疗效。方法　对 6 4例共 6 7侧开放性胫骨骨折采用带锁髓内钉治疗 ,其中非扩髓组 36侧 ,扩髓组 31侧。伤口愈合拆线后扶拐下地活动 ,术后定期随访 6个月～ 1年。结果　非扩髓组与扩髓组局部感染率分别是 13 9%和 12 9% (P >0 0 5 ) ,无全身感染 ;非扩髓组 5例锁钉断裂 ,扩髓组无断钉 ;非扩髓组与扩髓组平均骨折愈合时间分别为 2 2 5周和 17 2周 (P <0 0 5 )。延迟愈合分别为 5例、 3例 ,非扩髓组有 1例骨折不愈合。结论　与非扩髓组比较 ,扩髓带锁髓内钉具有骨折固定强度大、骨折愈合快、延迟愈合或不愈合少 ,感染率没有明显升高

A Comparing Study of the Effect of Open Tibial Fractures Using Reamed or Non-reamed Intramedullary Nails

Objective To retrospectively compare the clinical results of the treatment for open tibial fractures using reamed or non-reamed intramedullary nails.Methods Sixty-seven open tibial fractures (from 64 cases) were treated with intramedullary nails,36 fractures were in non-reamed group (Group A) and 31 in reamed group (Group B).The patients were admitted to move under the support of crutch after wound healing,and all patients were followed up regularly from 6 months to 1 year.Results No systematic infection happened but local infection occurred in 5 cases (13 9%) in Group A and 4 cases (12 9%) in Group B(P>0 05).Five broken wires were found in Group A but none in Group B.The average healing time of the fracture was 22 5 weeks in Group A,while 17 2 weeks in Group B(P<0 05).Five cases of delayed union occurred in Group A and 3 cases in Group B,one case of nonunion happened in Group A.Conclusion In comparison with the non-reamed nailing,reamed nailing can attain firm fixation,more rapid healing and less delayed union and nonunion,while the infectious rate is not increased significantly.