带锁髓内钉闭合复位穿钉治疗胫骨中下1/3段骨折

目的:带锁髓内钉闭合穿钉复位治疗胫骨中下1/3段骨折的临床应用。方法:对25例胫骨中下1/3段骨折应用闭合复位,23例行扩髓穿钉,2例未行扩髓穿钉,术后未使用任何形式的外固定支持,术后第 1d,应用 CPM进行关节功能锻炼,1周后进行关节主动锻炼。结果:25例均获随访,平均随访20个月(6月～30月),骨折平均愈合时间12周(6周～16周)。最终功能按Johner-wruch 标准:优22例,良3例,无断钉、骨折延迟愈合或不愈合、感染、脂肪栓塞、关节僵硬及再次骨折等并发症。结论:带锁髓内钉闭合复位穿钉治疗胫骨中下1/3段骨折具有内固定牢固、防止骨析端旋转、分离,血运影响小,术后不需外固定及能早期负重行走,骨折愈合率高,治疗效果可靠的特点,扩展了髓内钉的手术适应征。

Clinical Use of Intramedullary Interlocking Nail in Treatment of the Distal in Tibial Shaft Fracture

To study the clinical use of intramedullary interlocking nail in of treatment tibial fracture. Methods: 25 cases of tibial fractures were treated with intramedullary interlocking nail from May 1997 to May 2001. 25 cases were close reduction and internal fixation. Results: No additional external fixation of any form was started from the day after surgery and one week later, joint movement changed to active. All had healed 6-12 weeks after surgery, and the fixation nails were taken out after 12-18 months. No broken nail, delayed or nonunion, infection, stiff joint and refracutre occurred. Conclusion: The intramedullary interlocking nail had obvious advantage of reliable fixation, rotation prevention, no need of external fixation support, high rate of fracture healing and allowance of early exercise. It extended the indication to fractures which were more complex and distal in the tibial shaft. To master the operation skills might be the key point in advocating this now technique.