胫骨骨折外科手术方式的选择及其疗效比较(附245例报告)

目的通过回顾分析我院近4年进行手术治疗的胫骨骨折患者245例，评价其不同手术方式的临床疗效。方法对96例带锁髓内钉固定患者、137例钢板固定患者及12例外固定支架固定患者的术后并发症、术后负重时间和术后功能恢复情况进行分析和总结。结果96例带锁髓内钉固定组患者下地负重时间平均为18天，皮瓣坏死2例，骨筋膜室综合征1例，感染2例，疗效优良89例，一般及差7例；137例钢板固定组患者下地负重时间平均为82．9天，皮瓣坏死16例，骨筋膜窒综合征5例，感染6例，骨不连或畸形愈合5例，疗效优良115例，一般及差22例。12例外固定支架固定组患者平均下地负重时间为128．5天，皮肤坏死5例，感染3例，骨不连3例，疗效优良6例，差6例。相互之间比较有显著性差异（P〈0．05）。结论对于闭合性胫骨骨折患者，首选带锁髓内钉治疗，对于GustiloⅠ、Ⅱ、Ⅲa型骨折患者，可选用髓内钉或钢板治疗。而对于GutiloⅢb及ⅢC型骨折患者，忌用内固定治疗，首选外固定支架固定。

Comparison with the different surgical treatment of the tibial fracture and the effects:Analysis of 245 cases

Objective To discuss the clinical effects of the surgical treatment of the tibial fractures of 245 patients in current four years. Methods Ninety-six patients with interlocking intramedullary nail fixation, 137 patients with steel plate fixation and 12 patients with external equipment fixation were analyzed for the complication, weight-bearing time after surgery and the recovery of the function. Results The patient treated with interlocking intramedullary nail acquired a good recovery comparing with the other two groups. Conclusion For a closed tibial fracture, the interlocking intramedullary nail is the first choice. But for a severe open tibil fracture, external equipment fixation is the best choice.