Burç Halil, Dursun Muhsin, Orhun Haldun, Gürkan Volkan, Bayhan Ilhan
Ozel Göztepe Safak Hastanesi, Ortopedi ve Travmatoloji Kliniği, Istanbul, Turkey.
Acta Orthop Traumatol Turc. 2009 Jan-Feb;43(1):7-13. doi: 10.3944/AOTT.2009.007.
We evaluated the results of reamed and locked intramedullary nailing for tibial diaphysis fractures.
The study included 73 patients (68 males, 5 females; mean age 31 years; range 17 to 68 years) who were treated with reamed and locked intramedullary nailing for tibial diaphysis fractures. There were 28 AO/ASIF type A, 29 type B, and 16 type C fractures. The fractures involved the proximal 1/3 (n=12), middle 1/3 (n=50), and distal 1/3 (n=11) of the tibial diaphysis. Twenty-eight fractures (38.4%) were closed. According to the Gustilo-Anderson classification, 30 patients (41.1%) had grade I, 10 patients (13.7%) had grade II, and five patients (6.9%) had grade IIIA open fractures. Intramedullary nailing was performed following open reduction in 17 patients (23.3%), and closed reduction in 56 patients (76.7%). The mean time to surgery was 3.4 days (range 2 to 11 days) and the mean follow-up was 48 months (range 24 to 60 months). The patients were evaluated with respect to range of motion, time to union, and complications. Functional results were assessed using the Johner-Wrush criteria.
Union was achieved in all the patients within a mean of 18.2 weeks (range 8 to 52 weeks). Four patients required dynamization because of delayed union and grafting was performed in one patient. Transient sensorial deficit occurred in one patient after dynamization. One patient underwent revision surgery because of migration of the distal locking screws. The only limitation of range of motion was seen in flexion of two patients (2.7%) who developed anterior knee pain. According to the Johner-Wrush criteria, functional results were very good in 45 patients (61.6%), and good in 28 patients (38.4%).
Treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing is an appropriate choice with a low complication rate. It can be safely used in moderately contaminated open fractures.
我们评估了扩髓带锁髓内钉治疗胫骨干骨折的效果。
本研究纳入73例患者（68例男性，5例女性；平均年龄31岁；年龄范围17至68岁），这些患者接受了扩髓带锁髓内钉治疗胫骨干骨折。其中AO/ASIF A型骨折28例，B型骨折29例，C型骨折16例。骨折累及胫骨干近端1/3（12例）、中段1/3（50例）和远端1/3（11例）。28例骨折（38.4%）为闭合性骨折。根据Gustilo-Anderson分类，30例患者（41.1%）为I级开放性骨折，10例患者（13.7%）为II级开放性骨折，5例患者（6.9%）为IIIA级开放性骨折。17例患者（23.3%）在切开复位后行髓内钉固定，56例患者（76.7%）行闭合复位。平均手术时间为3.4天（范围2至11天），平均随访时间为48个月（范围24至60个月）。对患者的活动范围、骨折愈合时间和并发症进行评估。使用Johner-Wrush标准评估功能结果。
所有患者平均在18.2周（范围8至52周）内实现骨折愈合。4例患者因延迟愈合需要动力化处理，1例患者进行了植骨。1例患者在动力化处理后出现短暂感觉障碍。1例患者因远端锁定螺钉移位接受了翻修手术。仅2例患者（2.7%）出现前膝痛，导致活动范围受限。根据Johner-Wrush标准，45例患者（61.6%）功能结果非常好，28例患者（38.4%）功能结果良好。
扩髓带锁髓内钉治疗胫骨干骨折是一种合适的选择，并发症发生率低。它可安全用于中度污染的开放性骨折。
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