交锁髓内钉治疗开放性胫腓骨骨折的疗效

Ji Jianfei, Zhao Yinsong, He Xueyu, Zhou Yang

Department of Orthopedics, Zhejiang Provincial Corps Hospital of Chinese People's Armed Police Force, Jiaxing Zhejiang, 314000, PR China.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Mar;23(3):268-70.

OBJECTIVE

To determine the effect of interlocking intramedullary nail in treatment of open tibial and fibula fractures and analyze the method to promote the bone union.

METHODS

From December 2003 to June 2006, thirty-five patients with open tibial and fibula fracture were treated with emergency debridement, interlocked intramedullary fixation for tibia and fixed fibula at the same time. During operation, the bone marrow was collected and grafted into the fracture gaps. Among them, there were 27 males and 8 females, involving in 22 left legs and 13 right legs. Their ages ranged from 19 to 65 years, with an average of 34.7 years. The location of fracture was the middle of the tibia and fibula in 16 cases, the distal 1/3 of the tibia and fibula in 12 cases and the proximal 1/3 in 7 cases. According to the Gustilo classification of open injuries, there were 7 cases of type I, 19 cases of type II, 8 cases of type III a and 1 case of type III b. The mean range of knee motion was 48.3 degrees (45-70 degrees). The mean time from injury to operation was 4.3 hours (50 minutes to 7 hours).

RESULTS

The mean operation time was 94 minutes (60-132 minutes) and the mean blood loss was 122 mL (100-350 mL). The wound healed by first intention in 32 patients. Incision was sutured in 2 cases of type III a fractures after operation 4 days, gastrocnemius flap graft was performed in 1 case of type III b fracture 1 week after operation. They all achieve good healing. No fractures split off, no iatrogenic nerve and vascular injury occurred, no osteofascial compartment syndromes or deep vein thrombus happened. Tension blisters appeared in 1 case of type II fracture after operation and subsided after 5 days. Patients were followed up for 14-43 months (mean 22 months). The X-ray films showed that fracture union was observe in 30 cases after 14 weeks of operation, in 3 cases after 18 weeks and in 1 case after 22 weeks of operation. The fractures union time was 15.2 weeks on average. About 2 cm nonunion in lateral tibial appeared in 1 case of type I fracture. No fracture occurred again. The mean range of knee motion was 127 degrees (121-135 degrees). The mean HSS score was 96.5 (87-100) at the end of the follow-up. The excellent and good rate was 100%.

CONCLUSION

The curative effect of interlocking intramedullary nail is definite in treatment of open tibial and fibula fractures and it can enhance fracture union to plant bone marrow into the fracture gaps.

目的

探讨交锁髓内钉治疗开放性胫腓骨骨折的疗效及促进骨折愈合的方法。

方法

2003年12月至2006年6月，对35例开放性胫腓骨骨折患者行急诊清创、胫骨交锁髓内固定及同期腓骨固定术。术中采集骨髓植入骨折间隙。其中男27例，女8例，左侧22例，右侧13例。年龄19～65岁，平均34.7岁。骨折部位：胫腓骨中段16例，胫腓骨远端1/3处12例，近端1/3处7例。按Gustilo开放性损伤分类：Ⅰ型7例，Ⅱ型19例，Ⅲa型8例，Ⅲb型1例。膝关节平均活动范围48.3°（45～70°）。受伤至手术平均时间4.3小时（50分钟至7小时）。

结果

平均手术时间94分钟（60～132分钟），平均出血量122ml（100～350ml）。32例伤口一期愈合。2例Ⅲa型骨折术后4天缝合切口，1例Ⅲb型骨折术后1周行腓肠肌瓣移植术，均愈合良好。无骨折再移位，无医源性神经、血管损伤，无骨筋膜室综合征及深静脉血栓形成。1例Ⅱ型骨折术后出现张力性水疱，5天后消退。患者随访14～43个月（平均22个月）。X线片显示：术后14周骨折愈合30例，18周愈合3例，22周愈合1例。骨折平均愈合时间15.2周。1例Ⅰ型骨折胫骨外侧出现约2cm骨不连，无再次骨折发生。膝关节平均活动范围127°（121～135°）。随访末HSS评分平均96.5分（87～100分），优良率100%。