Finkemeier C G, Schmidt A H, Kyle R F, Templeman D C, Varecka T F
Department of Orthopaedics, University of California-Davis Medical Center, Sacramento, California, USA.
J Orthop Trauma. 2000 Mar-Apr;14(3):187-93. doi: 10.1097/00005131-200003000-00007.
To determine if there are differences in healing, complications, or number of procedures required to obtain union among open and closed tibia fractures treated with intramedullary (IM) nails inserted with and without reaming.
Prospective, surgeon-randomized comparative study.
Level One trauma center.
Ninety-four consecutive patients with unstable closed and open (excluding Gustilo Grade IIIB and IIIC) fractures of the tibial shaft treated with IM nail insertion between November 1, 1994, and June 30, 1997.
Interlocked IM nail insertion with and without medullary canal reaming.
Time to union, type and incidence of complications, and number of secondary procedures performed to obtain union.
For open fractures, there were no significant differences in the time to union or number of additional procedures performed to obtain union in patients with reamed nail insertion compared with those without reamed insertion. A higher percentage of closed fractures were healed at four months after reamed nail insertion compared with unreamed insertion (p = 0.040), but there was not a difference at six and twelve months. More secondary procedures were needed to obtain union after unreamed nail insertion for the treatment of closed tibia fractures, but the difference was not statistically significant given the limited power of our study (p = 0.155). Broken screws were seen only in patients treated with smaller-diameter nails inserted without reaming, and the majority occurred in patients who were noncompliant with weight-bearing restrictions. There were no differences in rates of infection or compartment syndrome.
Our findings support the use of reamed insertion of IM nails for the treatment of closed tibia fractures, which led to earlier time to union without increased complications. In addition, canal reaming did not increase the risk of complications in open tibia fractures.
确定在使用扩髓和不扩髓髓内钉治疗开放性和闭合性胫骨干骨折时，骨折愈合情况、并发症或达到骨愈合所需的手术次数是否存在差异。
前瞻性、外科医生随机对照研究。
一级创伤中心。
1994年11月1日至1997年6月30日期间，94例连续的胫骨干不稳定闭合性和开放性（不包括Gustilo IIIB级和IIIC级）骨折患者接受髓内钉内固定治疗。
带锁髓内钉内固定，分为扩髓和不扩髓。
骨愈合时间、并发症类型及发生率，以及为达到骨愈合而进行的二次手术次数。
对于开放性骨折，与未扩髓髓内钉内固定的患者相比，扩髓髓内钉内固定患者的骨愈合时间或为达到骨愈合而进行的额外手术次数无显著差异。与未扩髓髓内钉内固定相比，扩髓髓内钉内固定的闭合性骨折患者在4个月时愈合率更高（p = 0.040），但在6个月和12个月时无差异。闭合性胫骨干骨折采用未扩髓髓内钉内固定治疗时，为达到骨愈合需要更多的二次手术，但鉴于本研究的检验效能有限，差异无统计学意义（p = 0.155）。仅在使用未扩髓的小直径髓内钉治疗的患者中出现断钉情况，且大多数发生在未遵守负重限制的患者中。感染率和骨筋膜室综合征发生率无差异。
我们的研究结果支持在治疗闭合性胫骨干骨折时使用扩髓髓内钉内固定，这可使骨愈合时间更早且不增加并发症。此外，扩髓并未增加开放性胫骨干骨折的并发症风险。
