交锁髓内钉治疗开放性胫腓骨骨折并发症的原因分析及防治

目的] 观察交锁髓内钉治疗开放性胫腓骨骨折的并发症的原因及防治措施。方法]1999年1月～2004年12月用交锁髓内钉治疗开放性胫腓骨骨折120例。男76例，女44例；Gustilo Ⅰ型67例，Ⅱ型47例，Ⅲa型6例；左侧39例，右侧81例；年龄15～78岁，平均34．5岁；Gustilo Ⅰ，Ⅱ型均采用扩髓及静力型固定，Ⅲa型6例均未扩髓。结果] 120例均得到随访，平均30个月（2个月～5年）。愈合时间12～56周，平均27．4周。术中并发症有髓内钉开口错误3例，术中再骨折4例，小腿软组织损伤4例，锁钉误穿7例，大隐静脉和腓总神经损伤各1例；术后并发症主要有感染8例，膝关节疼痛3例，锁钉断裂4例：主钉断裂1例，骨折迟缓愈合12例，肢体短缩和膝关节内翻各1例。疗效根据Johner-Wruhs标准进行评分，优102例，良16例，差2例，优良率98.3％。结论] 交锁髓内钉治疗胫腓骨开放性骨折存在一定的并发症，在临床使用中必须引起高度重视；Gustilo Ⅱ以上骨折以不扩髓为宜。

Reason analysis and prevention of complications of the open tibial fractures treated with interlocking intramedullary nail

Objective] To observe complications of tibial shaft fractures with interlocking intramedullary nail treatment and investigate the causes and prevention.Method] A total of 120 cases of open tibial shaft fractures were treated with interlocking intramedullary nail from January 1999 to December 2004. There were 76 males and 44 females, and 39 fractures occurred in left tibia and 81 in right. According to the classification of Gustilo, 67 cases were type I, 47 cases were type II, 6 cases were type IIIa. The average age of the patients was 34.5 years (ranged, 15 ~ 78 years). The cases of type I, II were treated with reamed nails and static interlocking. The cases of type IIIa were treated with non-reamed nails.Results] All cases were followed up for an average of 30 months ( ranged, 2 month ~ 5 years). The average time to fracture union was 27.4 weeks( ranged, 12 ~ 56 weeks). The intraoperative complications included split of fracture end in 4 cases, injury of soft tissue in 4 cases , distal nailing failure in 7 cases, injury of great saphenous vein in 1 cases, and injury of common peroneal nerve in 1 case respectively. The postoperative complications included infection in 8 cases, pain of knee joint in 3 cases, screw broken in 4 cases, nail broken in 1 cases, delayed union in 12 cases, limb shortening in 1 case and genu varum in 1 case respectively. Evaluated according to the criteria of Johner-Wruhs, there were 102 cases assessed as being excellent, 16 as being good and 2 as being poor, the satisfactory rate was 98.3%.Conclusion]Interlocking intramedullary nail is a good internal fixation for tibial fractures, but complications should be prevented. Non-reamed interlocking intramedullary nail should be used in Gustilo III fractures.