Ⅰ期与择期带锁髓内钉治疗胫骨干开放性骨折比较

目的比较开放性胫骨干骨折Ⅰ期与择期带锁髓内钉治疗效果和并发症。方法102例123侧开放性骨折，分别按急诊清创后直接行带锁髓内钉固定和择期行带锁髓内钉固定两种方法进行治疗。结果随访半年以上，骨折全部愈合，膝、踝关节功能恢复良好。12侧胫骨皮肤不同程度坏死、缺损，但无感染，均行肌皮瓣修复，愈合后未影响肢体功能。Ⅰ期髓内钉内固定组在手术总时间、住院日、住院费用、抗生素用量、部分负重时间等方面显著优于择期手术，而手术后的疗效、并发症等方面差异无统计学意义。结论感染发生的危险性不是开放性胫骨干骨折带锁髓内钉治疗的绝对禁忌证，彻底清创、条件允许时可以Ⅰ期手术行带锁髓内钉内固定治疗。

Comparative analysis of immediate and selective interlocked intramedullary nailing for treatment of open tibial shaft fractures

Objective To compare the therapeutic effect and complication of immediate and selective interlocked intramedullary nailing in treatment of open tibial shaft fractures. Methods A total of 123 open tibial shaft fractures of 102 cases were treated with immediate fixation with interlocked intramedullary nailing after debridement (Group A) and with selective fixation with interlocking intramedullary nailing after debridement and closing the wound (Group B). Results The follow up for more than half a year showed that all fractures were healed, with excellent joint function of knee and ankle. Of all, 12 cases with skin necrosis and defect but without deep infection were healed after pedicle flap reconstruction. The result of Group A was much better than that of Group B in regard of total operation time, hospital stay, cost, amount of antibiotics used and partial weight bearing. No statistical difference in therapeutic effects and complications was found between two group. Conclusion Infection is not the contra-indication of interlocked intramedullary nailing in open tibial fractures. Immediate operation can be done after thorough debridement.