Woll T S, Duwelius P J
Oregon Health Sciences University, Division of Orthopedics and Rehabilitation, Portland 97201.
Clin Orthop Relat Res. 1992 Aug(281):204-7.
A series of 31 segmental tibial fractures is reported. Eighty-four percent of the patients sustained multiple trauma and 80% of these were open fractures. The series includes treatment with 20 external fixators, seven unreamed intramedullary nails, two casts, and two amputations. Complications included a 48% incidence of elevated compartment pressures necessitating fasciotomy. Despite rapid early decompression, there was a 19% incidence of residual motor and sensory deficit. Other complications observed were a 35% incidence of wound infection, nonunion, and malunion. Eighty-one percent of delayed or nonunions occurred at the distal fracture site. Intramedullary nailing produced the fewest complications. The segmental tibial fracture is at high risk for complications. Close observation of the limb for high compartment pressures is advisable. Treatment for compartment syndrome includes prompt decompression and stabilization of the fracture and, as indicated, intramedullary rods without preliminary reaming.
报道了一组31例胫骨干骨折。84%的患者遭受多发伤，其中80%为开放性骨折。该组病例包括使用20个外固定器、7根未扩髓髓内钉、2个石膏以及2例截肢的治疗情况。并发症包括48%的骨筋膜室压力升高发生率，需要进行筋膜切开减压术。尽管早期迅速减压，但仍有19%的患者出现运动和感觉功能残留缺损。观察到的其他并发症包括35%的伤口感染、骨不连和畸形愈合发生率。81%的延迟愈合或骨不连发生在骨折远端部位。髓内钉固定产生的并发症最少。胫骨干骨折发生并发症的风险很高。建议密切观察肢体有无骨筋膜室压力升高情况。骨筋膜室综合征的治疗包括迅速减压、骨折固定，如有必要，可使用未预先扩髓的髓内钉。
