交锁髓内钉治疗胫骨下段骨不连的临床观察

目的研究交锁髓内钉治疗胫骨下段骨不连的有效性。方法2002年2月～2007年1月,应用交锁髓内钉治疗胫骨下段骨不连47例,男29例,女18例;年龄18～61岁,平均33.6岁。其中肥大型20例,萎缩型14例,营养不良型13例。骨折冠状面成角0°～21°,平均8.5°;矢状位成角为0°～17°,平均6°。从受伤到交锁髓内钉固定时间为5～12个月,平均7个月。首次创伤为开放性骨折14例,闭合性骨折33例,无大于1.5cm的节段性骨质缺损,5例胫骨下段肥大型骨不连闭合置入髓内钉,折端未植骨;6例胫骨下端骨不连(肥大型3例,营养不良型3例)应用改良髓内钉治疗,所有病例均采用静力型固定。结果经随访6～26个月,平均13个月,45例经3～5个月获得愈合,平均愈合时间3.7个月。2例术后8个月骨折未愈合,经切开植骨、辅助石膏外固定3个月后愈合。术后无活动性感染及慢性骨髓炎发生。结论交锁髓内钉固定治疗胫骨下段骨不连具有良好的矫正畸形能力和最少量软组织剥离的优点。

The clinical observation of locked intramedullary nailing in the treatment of nonunion of the distal tibia

Objective To study the therapeutic effects of locked intramedullary nailing in the treatment of non-union of the distal tibia. Methods Forty-seven patients with non-union of the distal tibia were treated with locked intramedullary nailing from 2002.February to 2007.January. Among them, 29 patients were male and 18 female, ranging in age from 18 to 61 years(mean 33.6 years).Twenty patients were hypertrophic non-unions, 14 atrophic non-unions and 13 dystrophy non-unions. Coronal plane deformity averaged 8.5 degree(ranged from 0 to 21 degree)and sagittal plane deformity 6 degree(from 0 to 17 degree). The average time from initial fractures to our treatments of non-unions was 7 months(ranged from 5 to 12 months). Fourteen initial fractures were open injures and others were closed. The segmental bone defects were not more than 1.5 cm. Six patients with hypertrophic non-unions of the distal tibia were treated with closed nailing without adjuvant bone grafting. Existing nails were modified for the treatment of very distal tibial fractures (3 hypertrophic and 3 oligotrophic non-unions). All of the patients were statically locked for fixation. Results All the patients were followed up from 6 to 26 months(mean 13 months). Forty-five patients achieved reunion with an average of 3.7 months(ranged from 3 to 5 months)after locked intramedullary nailing. Non-union occurred still existed in two patient 8 months after operation. Being further treated with bone grafting and plaster external fixation for 3 months the patient was also completely recovered. No active infections and chronic osteomyelitis happened after surgery. Conclusion Locked intramedullary nailing is a reliable and safe method in the treatment of non-union of the distal tibia. It can produce excellent correction of deformity with minimal soft-tissue dissection.