锁定钢板外置技术在治疗胫骨骨折髓内钉术后感染中的应用

目的 探讨胫骨骨折髓内钉内固定治疗术后继发感染的治疗方案。方法 收集2010 年1 月～2019 年1 月本科收治的19 例胫骨骨折髓内钉内固定治疗术后感染患者的临床资料，并行回顾性分析，按照固定方式的不同将其分为锁定钢板外置组（钢板组）和外固定架组（外固定组），比较两组在骨折愈合时间、并发症等方面的差异。结果 19 例感染患者均获得随访，平均随访13 个月，感染均得到良好控制，骨折愈合，外固定组骨折愈合时间为（9.000±1.986）个月，钢板组为（9.444±1.467）个月，差异无统计学意义（t=0.549，P=0.590）。外固定组并发症发生率为80%，钢板组为22%，两组比较，差异有统计学意义（P=0.023）。结论 对于胫骨骨折行髓内钉内固定术后感染的患者，通过一期彻底清创、取出髓内钉、锁定钢板外置固定，可取得良好的预后，比外固定架固定更有优势。

Application of external locking plate in the treatment of infection after intramedullary nail internal fixation for tibial fractures

Objective To explore the treatment plan of secondary infection after intramedullary nail internal fixation for tibial fractures.Methods The clinical data of 19 patients with infection after intramedullary nail internal fixation for tibial fracture who were admitted to our department from January 2010 to January 2019 were collected and analyzed retrospectively.They were divided into the external locking plate group (the plate group) and the external fixator group(the external fixation group) according to different fixation methods.The differences in the fracture healing time and complications between the external locking plate group and the external fixator group were compared.Results All the 19 infected patients were followed up with an average follow-up of 13 months.The infection was well controlled,and the fracture healed.The fracture healing time of the external fixation group and the plate group was (9.000±1.986)months and (9.444±1.467) months.There was no statistical difference between the two groups(t=0.549,P=0.590).The incidence of complications was 80% in the external fixator group and 22% in the external locking plate group.There was a statistical difference between the two groups(P=0.023).Conclusion For patients with infection after intramedullary nail internal fixation for tibial fractures,a thorough debridement,removal of the intramedullary nail,and external fixation with a locking plate can achieve a good prognosis,which is more advantageous than external fixation.