Rommens P M, Broos P L, Stappaerts K, Gruwez J A
Department of General Surgery and Traumatology, University Clinics of Leuven, Belgium.
Injury. 1988 Nov;19(6):432-5. doi: 10.1016/0020-1383(88)90141-6.
A series of 95 patients with fresh fractures of the shaft of the tibia, treated primarily with a Vidal-Adrey transfixation frame, was studied retrospectively. Only 20 fractures (21.0 per cent) attained clinical and radiological consolidation within 4 months after injury. Pseudoarthrosis was seen in 12 patients (12.9 per cent). The external fixator was attached for an average time of 25.0 weeks. Pin loosening was seen in seven patients (7.3 per cent), minor pin track infection in nine (9.4 per cent) and major pin track infection in three (3.1 per cent). In 31 patients (32.6 per cent) a second operative procedure was necessary to accelerate fracture healing. In 17 patients an autologous bone graft was carried out with the external fixator in place. Internal stabilization was performed after removal of the external fixator frame in 14 cases, at an average time of 9.4 months after injury. In difficult fractures we feel that change from external to internal fixation should be performed earlier; it makes early removal of the fixator pins possible and prevents the problems associated with prolonged use of fixator frames. The internal fixation, eventually combined with a transplantation of cancellous autografts, creates a mechanical and biological stimulus for bone consolidation. Functional recovery may also be improved because of a shorter healing time.
对95例主要采用维达尔-阿德里穿针固定架治疗的胫骨干新鲜骨折患者进行了回顾性研究。受伤后4个月内仅有20例骨折（21.0%）达到临床和影像学愈合。12例患者（12.9%）出现了骨不连。外固定架的平均使用时间为25.0周。7例患者（7.3%）出现了钢针松动，9例（9.4%）出现了轻微的针道感染，3例（3.1%）出现了严重的针道感染。31例患者（32.6%）需要进行第二次手术以加速骨折愈合。17例患者在保留外固定架的情况下进行了自体骨移植。14例患者在拆除外固定架后进行了内固定，平均时间为受伤后9.4个月。对于复杂骨折，我们认为应更早地从外固定转换为内固定；这使得早期拔除固定针成为可能，并防止了与长时间使用固定架相关的问题。最终结合松质骨自体移植的内固定为骨愈合创造了机械和生物学刺激。由于愈合时间缩短，功能恢复也可能得到改善。
