Dent J A, Hadden W A
Department of Orthopaedic Surgery, Royal Infirmary, Dundee.
Injury. 1987 Jan;18(1):28-32. doi: 10.1016/0020-1383(87)90381-0.
The records of 54 patients treated with interfragmentary screws were reviewed a mean of 2 years after surgery. Fifty-one fractures were of moderate severity (Ellis, 1950), 31 had a ratio of fracture length to tibial diameter of 2 or more and 17 were comminuted. An anatomical reduction, achieved initially in 44 fractures, was lost before union occurred in 14 (32 per cent), despite plaster splintage. Excellent results, with anatomical healing, were achieved in 30 patients (55 per cent) and good results with less than 5 degrees malalignment in 6 (11 per cent). There was a statistically highly significant association of satisfactory results with initial anatomical operative reduction of the fracture, a ratio of fracture length to tibial diameter of 2 or more and the absence of comminution. The orientation and number of screws, delayed operation, the degree of initial displacement of the fracture and the patient's age were not shown to affect the outcome. Delayed union occurred in 4 patients (7.4 per cent) and non-union in 3 (5.5 per cent). Deep infection occurred twice (3.7 per cent). As more satisfactory results could be expected for these fractures using other techniques, we conclude that this method cannot be recommended.
对54例采用骨折块间螺钉治疗的患者记录进行了回顾，平均随访时间为术后2年。51例骨折为中度严重程度（埃利斯，1950年），31例骨折长度与胫骨直径之比为2或更大，17例为粉碎性骨折。44例骨折最初实现了解剖复位，尽管采用了石膏夹板固定，但在骨折愈合前仍有14例（32%）出现复位丢失。30例患者（55%）获得了解剖愈合的优异结果，6例患者（11%）获得了成角畸形小于5度的良好结果。令人满意的结果与骨折最初的解剖手术复位、骨折长度与胫骨直径之比为2或更大以及无粉碎性骨折在统计学上具有高度显著的相关性。螺钉的方向和数量、延迟手术、骨折最初的移位程度以及患者年龄均未显示会影响治疗结果。4例患者（7.4%）发生延迟愈合，3例患者（5.5%）发生不愈合。深部感染发生2例（3.7%）。由于使用其他技术对这些骨折有望获得更满意的结果，我们得出结论，该方法不推荐使用。
