Simko P, Slivka M, Brix M, Látal J
Traumatologická klinika ILF, Limbová, Bratislava.
Bratisl Lek Listy. 1991 Aug;92(8):392-401.
Indications of appropriate treatment of tibial shaft fractures are one of the priority problems present-day traumatology has to address. In choosing the optimal mode of treatment of tibial shaft fractures not only the configuration of the fracture but also injury of soft tissues has been assigned increasing importance. At the Department of Traumatology of the Postgraduate Institute of Medicine in Bratislava, 962 tibial shaft fractures were treated over the period of 12 years from 1977-1988. Conservative treatment was applied in 600 fractures and 362 fractures were treated surgically. The therapeutic results obtained by using the newly introduced methods of treating tibial shaft fractures, i.e. functional plating and osteosynthesis by flexible Ender nailing, were analyzed in a retrospective and prospective study. The results of these approaches were compared with those achieved by classical methods of the AO school, rigid intramedullary nailing and external fixation. The favorable outcome of union and the good functional effect obtained in the studied and compared series of patients indicate that conservative functional treatment is the method of choice in tibial shaft fractures. Of the surgical therapeutic methods, flexible as well as stable intramedullary osteosynthesis by Ender nailing proved to be both the most sparing and the most physiological approach. The paper proposes an indication scheme of tibial shaft fracture treatment designed for clinical use considering the categorization of fractures according to up-to-date classification. For each type of tibial shaft fracture and soft tissue injury the optimal mode of treatment is suggested. Besides the main indication, possibilities of alternative treatment are also being pointed out.
胫骨干骨折的恰当治疗指征是当代创伤学必须解决的首要问题之一。在选择胫骨干骨折的最佳治疗方式时，不仅骨折的形态，软组织损伤也越来越受到重视。在布拉迪斯拉发医学研究生学院创伤科，1977年至1988年的12年间共治疗了962例胫骨干骨折。600例骨折采用保守治疗，362例骨折采用手术治疗。通过回顾性和前瞻性研究分析了采用新引入的胫骨干骨折治疗方法，即功能性钢板固定和弹性Ender钉内固定术所获得的治疗结果。将这些方法的结果与AO学派的经典方法、坚强髓内钉固定和外固定所取得的结果进行了比较。在研究和比较的患者系列中获得的良好愈合结果和良好功能效果表明，保守功能治疗是胫骨干骨折的首选方法。在手术治疗方法中，Ender钉弹性和坚强髓内固定被证明是最微创且最符合生理的方法。本文根据最新分类对骨折进行分类，提出了一种供临床使用的胫骨干骨折治疗指征方案。针对每种类型的胫骨干骨折和软组织损伤，建议了最佳治疗方式。除了主要指征外，还指出了替代治疗的可能性。
