超远端胫骨髓内钉治疗胫骨远端干骺端骨折的疗效分析

目的 评价超远端胫骨髓内钉治疗开放性或潜在开放性(Tscherne分型为2度、3度)的胫骨远端干骺端骨折的安全性与有效性.方法 2007年3月至2008年4月共收治15例胫骨远端骨折患者,男9例,女6例;年龄21～53岁,平均34.3岁.对于Gustilo Ⅰ型、Ⅱ型开放性骨折患者,于伤后6～48 h采用超远端胫骨髓内钉治疗;对于Gustilo Ⅲ型开放性骨折患者,将该髓内钉作为分期治疗策略中的最终治疗.对于闭合性骨折患者,先予消肿抗炎等对症处理,待肢体皮肤褶皱出现、局部软组织无红肿渗液时手术.通过随访患者影像学资料及术后1年Johner-Wruhs评分标准评估其临床疗效.结果 15例患者术后获12～18个月(平均14个月)随访;骨折愈合时间为18～25周(平均21.1周),所有患者均获解剖或功能复位.术后1年根据Johner-Wruhs评分标准评价疗效:优11例,良3例,可1例,优良率为93.3%.并发症:伤口浅层感染3例,皮肤局部坏死2例,经清创换药后愈合.未发生深部及髓内感染,无畸形愈合或不愈合发生.结论 对于开放性及潜在开放性胫骨远端干骺端骨折,超远端胫骨髓内钉是一种安全、有效的选择.

Abstract：

Objective To evaluate the safety and efficacy of extra-distal tibial intramedullary nailing for open and potentially open fractures of distal metaphyseal tibia.Methods Between March 2007 and April 2008, 15 patients (9 men and 6 women), with a mean age of 34.3 (from 21 to 53) years, were admitted to this study.For Gustilo Ⅰ and Ⅱ fractures, extra-distal tibial intramedullary nailing was performed 6 to 48 hours after injury; for Gustilo Ⅲ fractures, the intramedullary nailing was conducted as the definitive procedure of a staged strategy; for closed fractures, the operation was not performed until swelling subsided and exudation stopped following symptomatic treatments.All the patients were followed up by periodic X-ray examination.Functional outcomes were evaluated according to Johner-Wruhs criteria one year after surgery.Results The patients obtained a mean follow-up of 14 months (range, 12 to 18) after surgery.Anatomic or functional reduction was achieved and maintained in all the cases.The fractures healed 21.1 weeks (range,18 to 25) after surgery.By Johner-Wruhs criteria, the final outcomes were excellent in 11 cases (73.3%),good in 3 (20%), and fair in one(6.7% ).Complications included 3 cases of superficial infection and 2 cases of local skin necrosis, all responding to debridement and dressing.No deep infection, malunion or nonunion occurred.Conclusion Extra-distal tibial nail is a safe and effective alterative solution for open and potentially open fractures of distal metaphyseal tibia.

Extra-distal tibial intramedullary nail for open and potentially open fractures of distal metaphyseal tibia

Objective To evaluate the safety and efficacy of extra-distal tibial intramedullary nailing for open and potentially open fractures of distal metaphyseal tibia.Methods Between March 2007 and April 2008, 15 patients (9 men and 6 women), with a mean age of 34.3 (from 21 to 53) years, were admitted to this study.For Gustilo Ⅰ and Ⅱ fractures, extra-distal tibial intramedullary nailing was performed 6 to 48 hours after injury; for Gustilo Ⅲ fractures, the intramedullary nailing was conducted as the definitive procedure of a staged strategy; for closed fractures, the operation was not performed until swelling subsided and exudation stopped following symptomatic treatments.All the patients were followed up by periodic X-ray examination.Functional outcomes were evaluated according to Johner-Wruhs criteria one year after surgery.Results The patients obtained a mean follow-up of 14 months (range, 12 to 18) after surgery.Anatomic or functional reduction was achieved and maintained in all the cases.The fractures healed 21.1 weeks (range,18 to 25) after surgery.By Johner-Wruhs criteria, the final outcomes were excellent in 11 cases (73.3%),good in 3 (20%), and fair in one(6.7% ).Complications included 3 cases of superficial infection and 2 cases of local skin necrosis, all responding to debridement and dressing.No deep infection, malunion or nonunion occurred.Conclusion Extra-distal tibial nail is a safe and effective alterative solution for open and potentially open fractures of distal metaphyseal tibia.