Vidyadhara S, Sharath K Rao
Trauma and Joint Replacement Services, Department of Orthopaedics, Kasturba Medical College, Manipal 576104, Karnataka, India.
Injury. 2006 Jun;37(6):536-42. doi: 10.1016/j.injury.2006.01.042. Epub 2006 Apr 24.
Almost 9% of tibial shaft fractures occur in the proximal third of the bone. In order to address the problems of mal-alignment and late loss of fixation, all the specific surgical techniques described in the literature were used in nailing these fractures in our study.
From December 2001 to December 2003, 45 consecutive patients with fracture of the proximal third of the tibial shaft underwent nailing. The clinico-radiological outcome of these cases and the complications encountered were analysed.
The average time to knee mobilisation and partial weight-bearing walking was 3.2 days. The fractures had united at an average of 4.3 months. At the last follow up, the average lower extremity functional score was 96%. There were seven cases of malunion (15.56%), with three valgus and four apex anterior angulations. Delayed union necessitated open bone grafting in three cases, at an average of 6.3 months. At 8 months, one patient with delayed union experienced nail breakage across the weakest point, i.e. the dynamic screw hole. He underwent reamed exchange nailing and, 3 months later, the fracture had united.
Meticulous intramedullary nailing of fractures of the proximal third of the tibial shaft, using all current surgical principles and techniques, has excellent clinico-radiological outcome and is relatively safe. We recommend a nail similar to a Sirus nail, but with a more proximal bend of the nail and no dynamic interlocking screw hole.
近9%的胫骨干骨折发生在胫骨近端三分之一处。为了解决对线不良和内固定后期失效的问题，我们在本研究中采用了文献中描述的所有特定手术技术来治疗这些骨折。
2001年12月至2003年12月，45例连续的胫骨近端三分之一处骨折患者接受了髓内钉固定术。分析了这些病例的临床放射学结果及所遇到的并发症。
膝关节活动和部分负重行走的平均时间为3.2天。骨折平均在4.3个月时愈合。在最后一次随访时，下肢功能平均评分为96%。有7例畸形愈合（15.56%），其中3例为外翻畸形，4例为向前成角畸形。3例延迟愈合患者平均在6.3个月时需要行切开植骨术。8个月时，1例延迟愈合患者的髓内钉在最薄弱点即动力螺钉孔处发生断裂。该患者接受了扩髓交锁髓内钉置换术，3个月后骨折愈合。
采用目前所有的手术原则和技术，对胫骨近端三分之一处骨折进行细致的髓内钉固定术，具有良好的临床放射学效果且相对安全。我们推荐一种类似于Sirus髓内钉，但近端弯曲度更大且无动力交锁螺钉孔的髓内钉。
