交锁髓内钉与外支架治疗严重胫骨开放性骨折的疗效分析

目的:评价交锁髓内钉与外支架治疗严重胫骨开放性骨折的临床疗效。方法:严重胫骨开放性骨折患者39例,采用单侧外固定支架固定19例,男13例,女6例;年龄19~72岁,平均39岁;稳定性骨折7例,不稳定性骨折12例;合并其他部位骨折7例,颅脑损伤1例,腹部损伤2例。采用交锁髓内钉固定20例,男14例,女6例;年龄22~70岁,平均42岁;稳定性骨折8例,不稳定性骨折12例;合并其他部位骨折8例,颅脑伤2例,腹部伤1例。两组最初的伤口清创、软组织缺损的皮瓣移植修复是相同的。结果:随访时间平均为20个月(18~35个月),交锁髓内钉组骨折愈合时间(6·0±2·6)个月,外支架组骨折愈合时间为(7·0±2·5)个月。交锁髓内钉组膝关节的活动范围为115°±10°,踝关节为30°±5°,外支架组膝关节的活动范围为110°±5°,踝关节为27°±4°,髓内钉组功能恢复较好,成角畸形小。外支架组1例深部感染,4例钉道感染,髓内钉组1例深部感染。按功能评定标准,髓内钉组中优8例,良7例,中2例,差3例;外支架组中优4例,良5例,中3例,差7例。两组差异具有统计学意义(P<0·05)。比较骨折愈合时间、部分负重时间、踝膝关节的活动范围,两组之间无显著性差异。结论:在彻底清创,并且具备即刻或早期皮瓣修复的技术条件下,交锁髓内钉是治疗严重胫骨开放性骨折的理想选择。

Analysis of the effect on severe open tibial fracture treated with locked intramedullary nailing and external fixation

Objective:To analyse the effect of interlocking intramedullary nailing and external fixation for treatment of severe open tibial fractures.Methods:Thirty-nine patients with severe open tibial fracture were divided into two groups according to the fixation.Of 39 patients,19 (13 male and 6 female; the average age of 39 years ranging from 19 to 72 years) were treated by interlocking intramedullary nailing.There were 7 cases of stable fracture and 12 of unstable fracture,complicating other fracture in 7 cases,craniocerebral injuries in 1 case, abdominal injuries in 2 cases;20 (14 male and 6 female;the average age of 42 years ranging from 22 to 70 years) were treated by external fixation. There were 8 cases of stable fracture and 12 of unstable fracture,complicating other fracture in 8 cases,craniocerebral injuries in 2 cases,abdominal injuries in 1 case.Both groups had the same initial debridment and coverage of the soft-tissue defect with pedicled flaps.Results:The mean follow-up period was 20 months.In the interlocking intramedullary nail group,the time to fracture healing was (6.0±2.6) months,and the range of motion respectively was 115°±10°in the knee and 30°±5° in the ankle at the final follow-up.In the external fixation group,the time to fracture healing was (7.0±2.5) months,and the range of motion was respectively 110°±5° in the knee and 27°±4° in the ankle at the final follow-up.The interlocking intramedullary nail group had slightly better motion and less final angulation.Complications included one deep infection and four pin-track infections in external fixation group and one deep infection in the external fixation group.According the function standard,in interlocking intramedullary nail group the result were excellent in 8 cases,good in 7 cases,fair in 2 cases,poor in 3 cases;in external fixation group the result were excellent in 4 cases,good in 5 cases,fair in 3 cases,poor in 7 cases.There were significant statistical difference between two groups.The differences in fracture healing and range of motion were not statistically significant.Conclusion:With the ability to debride wound radically and transfer vascularized tissue into the traumatic defect,interlocking intramedullary nailing is the best choice for severe open tibial frcture.