多种固定方式在胫骨干骨折治疗中的应用与评价

目的 探讨Bastinni外固定支架,AO外固定支架,LC-DCP钢板,扩髓及不扩髓交锁髓内钉治疗胫骨干骨折的临床疗效,以及各型胫骨干骨折的固定方式选择.方法 对1998～2005年应用Bastinni外固定支架,AO外固定支架,LC-DCP钢板,扩髓及不扩髓交锁髓内钉治疗胫骨干骨折的临床疗效进行回顾性分析.结果 Bastinni外固定支架,AO外固定支架,LC-DCP钢板,扩髓及不扩髓交锁髓内钉治疗开放性胫骨干骨折平均手术103、67、113、152和107 min,平均出血272、231、203、390和216 mL,平均愈合7.2、6.7、7.4、6.9和6.3个月,优良率分别为67%、83%、75%、79%和78%;治疗闭合性胫骨干骨折平均手术97、66、114、142和103 min,平均出血233、247、198、398和223 mL,平均愈合时间为6.8、6.1、6.6、5.6和6.1个月,优良率分别为75%、83%、87%、94%和89%.结论 胫骨干骨折手术方式选择:在开放性骨折创面损伤大时选AO外固定架,闭合骨折选髓内钉或钢板治疗,选钢板时注意创面能用皮瓣覆盖,能容纳额外容量,对伴发颅脑损伤或胸腹外伤须缩短手术时间选择AO外固定支架.

Application and assess of different fixation system for fractures of tibia

[Objective] To have a comparison between Bastinni external fixator,AO external fixator,LC-DCP,reamed interlocking nail and unreamed interlocking nail,and assess their clinical value.[Methods] In a restrospective study,17 patients were treated with Bastinni external fixator,24 patients were treated with AO external fixator,42 patients were treated with LC-DCP,31 patients were treated with reamed interlocking nail and 18 patients were treated with unreamed interlocking nail.[Results] The five groups were followed up,in the open fractures of tibia:operative time of Bastinni external fixator,AO external fixator,LC-DCP,reamed interlocking nail and unreamed interlocking nail were:103,67,113,152,107 minutes.Blood loss were:272,231,203,390 and 216 mL.Healing time were:7.2,6.7,7.4,6.9,6.3 months.The excellent and good rate were 67%,83%,75%,79%,78%,in the close fractures of tibia:operative time of Bastinni external fixator,AO external fixator,LC-DCP,reamed interlocking nail and unreamed interlocking nail were:97,66,114,142,103 minutes.Blood loss were:233,247,198,398 and 223 mL.Healing time were:6.8,6.1,6.6,5.6,6.1months.The excellent and good rate were 75%,83%,87%,94%,89%.[Conclusion] AO external fixator is best for open tibial fracture,interlocking nail and LC-DCP are good for close tibial fracture.Extra volume is required in the use of LC-DCP.AO external fixator is also best for open tibial fracture with complex injury.