三种固定方法治疗胫腓骨骨折的疗效比较

目的比较3种固定方法治疗胫腓骨骨折的疗效。方法回顾性分析从1996年12月～2004年12月不同方法治疗的胫腓骨骨折160例,其中外固定架10例,AO加压钢板50例,交锁钉100例。结果随访8～12个月,平均11个月,疗效优良率:外固定架84%,AO钢板90%,交锁钉99%。3种方法固定骨折均愈合,但有并发症。延迟愈合5例:交锁钉1例,外固定支架1例,AO加压钢板3例;感染4例:外固定支架2例,AO加压钢板2例;固定物断裂3例。AO加压钢板2例,交锁钉1例;骨不连4例:外固定支架1例,AO加压钢板3例;畸形愈合3例:外固定支架1例,AO加压钢板2例。结论交锁钉可广泛应用于闭合性胫腓骨复杂骨折且优于AO钢板及外固定支架,它具有微创及符合生物学内固定的优点,术后骨折愈合较为理想,若能早期功能锻炼,相对并发征较少。AO钢板应慎用于胫骨中下1/3段复杂闭合性骨折,外固定支架对于开放性骨折是上述方法的补充。

Comparison of therapeutic effects on tibial and fibular fracture with three different fixation methods

Objective To compare therapeutic effect of tibial and fibular fracture on the use of three different fixation methods. Methods From December 1996 to December 2004, 160 cases of tibial and fibular fracture received treatment of different methods were analyzed retrospectively. Among them, 10 cases were treated with external fixator, 50 cases AO compressed steel plates and 100 cases intramedullary interlocking nail. Results All cases were followed-up for 8-12 months, average followed-up period were 11 months after operation. The rate of excellence and good were 84% in external fixator, 90% in AO compressed steel plates and 99% in intramedullary interlocking nail respectively. The postoperative complications were delayed union in 5 cases, in which 1 was in external fixator, 3 was in AO compressed plates and 1 was in intramedullary interlocking nail, infection in 4 cases in which 2 was in external fixator and 2 was in AO compressed plates, fixation appliances broken in 3 cases in which 2 was in AO compressed plates and 1 was in intramedullary interlocking nail, fracture nonunion in 4 cases in which 1 was in external fixator, 3 was in AO compressed plates, abnormal fracture healing in 3 cases in which 1 was in external fixator, 2 was in AO compressed plates. Conclusion the rapeutic effect of tibial and fibulal fracture treated by intramedullary interlocking nail is more satisfied than by external fixator and AO compressed plates. The intramedullary interlocking nail was considered as an effective means of treatment of tibial and fibulal fracture with little hurt of operation, good anatomy reposition, high rate of fracture healing,early function exercise and rare complications. It shoud be careful that the fracture of 1/3 middle and lower segment of the tibia was treated by AO plate. The exterior external fixator were an additional mean in treating opened fracture.