Djahangiri Ali, Garofalo Raffaele, Chevalley François, Leyvraz Pierre-François, Wettstein Michael, Borens Olivier, Schizas Constantin, Mouhsine Elyazid
Orthopedic and Traumatology Department, University Hospital of Lausanne, Switzerland.
Med Princ Pract. 2006;15(4):293-8. doi: 10.1159/000092993.
To evaluate the results of closed and open grade I and II tibial shaft fractures treated by reamed nail and unreamed nailing.
Between 1997 and 2000, 119 patients with tibial shaft fractures were treated with reamed tibial nails. Postoperatively 96 patients (70 closed and 26 grade I and II open fractures) were followed clinically and radiologically for up to 18 months. The nail was inserted either by patellar tendon splitting or by nonsplitting technique. The nail was inserted after overreaming by 1.5 mm. Postoperatively, patients with isolated tibial fracture were mobilized by permitting partial weight bearing on the injured leg for 6 weeks. Patients with associated ankle fractures were allowed to walk with a Sarmiento cast.
Postoperatively, 6 (6.3%) patients developed a compartment syndrome after surgery. In 48 (50%) cases, dynamization of the nail was carried out after a mean period of 12 weeks for delayed union. Overall, a 90.6% union was obtained at a mean of 24 weeks without difference between closed or open fractures. Two (2.1%) patients with an open grade II fracture developed a deep infection requiring treatment. A 9.4% rate of malunion was observed. Eight (8.3%) patients developed screw failure without clinical consequences. At the last follow-up, 52% of patients with patellar tendon splitting had anterior knee pain, compared to those (14%) who did not have tendon splitting.
Reamed intramedullary nail is a suitable implant in treating closed as well as grade I and II open tibial shaft fractures.
评估采用扩髓髓内钉和非扩髓髓内钉治疗闭合性以及Ⅰ级和Ⅱ级胫骨干骨折的效果。
1997年至2000年间，119例胫骨干骨折患者接受了扩髓胫骨髓内钉治疗。术后对96例患者（70例闭合性骨折以及26例Ⅰ级和Ⅱ级开放性骨折）进行了长达18个月的临床和影像学随访。髓内钉通过髌腱劈开或非劈开技术置入。在扩大髓腔1.5毫米后插入髓内钉。术后，单纯胫骨干骨折患者在伤腿部分负重的情况下活动6周。伴有踝关节骨折的患者使用萨米恩托支具行走。
术后，6例（6.3%）患者术后发生骨筋膜室综合征。在48例（50%）病例中，因骨折延迟愈合，平均在12周后对髓内钉进行了动力化处理。总体而言，平均24周时骨折愈合率为90.6%，闭合性骨折和开放性骨折之间无差异。2例（2.1%）Ⅱ级开放性骨折患者发生深部感染需要治疗。观察到畸形愈合率为9.4%。8例（8.3%）患者出现螺钉失效，但未产生临床后果。在最后一次随访时，髌腱劈开的患者中有52%存在前膝疼痛，而未进行腱劈开的患者中这一比例为14%。
扩髓髓内钉是治疗闭合性以及Ⅰ级和Ⅱ级开放性胫骨干骨折的合适植入物。
