微创弹性髓内钉结合外固定支架治疗粉碎性闭合胫腓骨干骨折

目的:探讨微创弹性髓内钉结合外固定支架治疗粉碎性闭合胫腓骨干骨折的疗效。方法:2010年6月至2012年6月采用微创弹性髓内钉结合外固定支架技术治疗58例粉碎性闭合胫腓骨骨干折患者,男31例,女27例;年龄21～57岁,平均38.5岁。骨折按AO分型,B1型9例,B2型7例,B3型10例,C1型14例,C2型12例,C3型6例。根据Winquist -Hanson粉碎分级,1级23例,2级17例,3级12例,4级6例。终末随访根据Johner-Wruhs评分比较各治疗组患者疗效。结果:58例均获随访,时间18～36周,平均6.8个月。58例均获得骨性愈合,临床愈合时间为24～32周,平均28周。1级粉碎组优良率在明显高于其他3组,并发症的发生率随粉碎级别增高而增高,愈合时间随着粉碎级别增高而延长。C3型骨折并发症发生率明显高于其他组,优良率明显低于其他组,B1型骨折并发症发生率明显低于其他组,优良率明显高于其他组。结论:微创弹性髓内钉结合外固定支架技术治疗多段、长螺旋轻中度粉碎伴隐匿骨裂闭合性胫腓骨骨折能够获得满意的复位和可靠的固定,完全符合BO原则,最大程度保护了骨折端血运,减少带架时间,皮肤软组织并发症少,术后功能恢复满意。

Minimal invasive elastic intramedullary nails and external fixation for treatment of comminuted closed fracture of tibia-fibula shaft

Objective:To investigate the clinical results of external fixation and AO titanium elastic intramedullary nailing for treatment of tibia-fibula comminuted closed fractures. Methods:From June 2010 to June 2012,58 patients with tibia-fibula comminuted closed fractures were treated with external fixation and AO titanium elastic intramedullary nailing,including 31 males and 27 females with an average age of 38.5 years old ranging from 21 to 57 years old. According to the system of AO Classification,the fractures were classified as type B1 in 9 cases,type B2 in 7 cases,type B3 in 10 cases,type C1 in 14 cases,type C2 in 12 cases,and type C3 in 6 cases. According to the system of Winquist-Hanson,the fractures' comminuted were classified as grade 1 in 23 cases,grade 2 in 17 cases,grade 3 in 12 cases,and grade 4 in 6 cases. According to the system of Johner-Wruhs,clinical results were compared between different type and grade groups by the time of last followed-up. Results:All 58 patients were followed up with an average time of 6.8 months (ranged from 18 to 36 weeks). All fractures had clinical healing with an average time of 28 weeks(ranged from 24 to 32 weeks). The total rate of good to excellent results was 91.4%. The rate of good to excellent in the group of grade 1 was higher than that of other grades. The complication rates and fracture healing time would increase respectively with higher Winquist-Hanson's grade. The complication rates in the group of type C3 was higher than that of other types,but the rate of good to excellent was lower than that of other types. The complication rates in the group of type B1 was lower than that of other types,but the rate of good to excellent was higher than that of other types. Conclusion:Minimal invasiveusing AO titanium elastic intramedullary nailing combined with external fixation for treatment of tibia-fibula fractures especially for the multiple-segment,long spiral mild-to-moderate comminuted with hidden fracture can get satisfactory reduction and reliable fixation,it conformes to the principle of BO completely,protects the fracture end blood supply,reduces the external fixation time,has less skin soft tissue complications,postoperative function recovered satisfactorily.