微创交锁钉治疗胫骨干长节段粉碎性骨折46例分析

[目的]阐明闭合或有限切开复位交锁髓内钉内固定微创治疗胫骨干多节段粉碎性骨折的优越性和手术要点。[方法]选取46例胫骨干长节段粉碎性骨折使用微创交锁髓内钉固定为治疗组,随机选取同时期普通钛板治疗多节段骨折46例为对照组,对两组术中情况及术后疗效进行比较,其中治疗组采用闭合复位穿钉,有限切开复位螺钉固定,瞄准器锁定骨折远、近端。[结果]两组术后均随访12个月以上,两组在手术时间、住院时间、术中出血量及骨折愈合时间、远期功能疗效满意度方面均有显著性统计学差异。[结论]闭合或有限切开复位交锁髓内钉治疗胫骨干长节段粉碎性骨折较钛板有着微创、手术时间短、伤口愈合快、住院时间短,更符合胫骨生物力学、更高骨折愈合率、更少并发症等优越性。微创交锁钉为该类骨折提供了最佳骨折愈合时机、良好功能恢复,可避免关节僵硬,大部分患者可重返工作岗位。

Microtraumatic treatment of tibial long-fragments comminuted shaft fracture by interlocking intramedullary nails

[Objective] To explore the superiority and the key of microtraumatic operation of interlocking intramedullary nail with tris-dimension aim implement in treating tibial shaft long-fragments comminuted fractures.[Methods]Forty-six cases of shaft long-fragments comminuted shaft fractures(treatment group) were treated with interlocking intramedullary nails by static locking.The comminuted fractures with difficult reduction were locally opened with a limited incision,and the two sides of the fracture were locked with nails by an aim implement.The results of operation period,hemorrhage quantitative,fracture healing period and long term effect were compared with forty-six cases at the same time treated with plates(control group).[Results]All cases were followed up(above 12 months).Long term effect was evaluated by Johner Wruh evaluation standard.The difference of the above index of the two groups was signficant(P<0.05).[Conclusion]Applying interlocking intramedullary nails is a principal way in treating tibial shaft long-fragments fractures because of its microtrauma and its coincidence with the tibial biomechanics environment when compared with plate.Interlocking reamed intramedullary nails offer the best time to union,function outcome,prevention of joint stiffness and return to activities in most circumstances.