Garland D E, Saucedo T, Reiser T V
Clin Orthop Relat Res. 1986 Dec(213):237-40.
Of 34 tibia fractures in 28 acute spinal cord injuries, 13 patients had complete and 15 had incomplete neurologic lesions. Tibia fractures were divided into three groups: Group I, nonoperative treatment; Group II, early open reduction and internal fixation; and Group III, Type III open injuries. Group I included 17 fractures, of which nine (53%) had delayed union, malunion, or nonunion. The average time to union was 6.5 months. Seven patients had pressure sores and pulmonary emboli. Eleven fractures were noted in Group II. One delayed union (9%), one superficial wound infection that healed uneventfully, and one deep vein thrombosis were noted. The average time to union was 12 weeks. All six Group III tibias had delayed and nonunions, regardless of treatment. Nonoperative fractures healed at a prolonged rate, while open reduction and internal fixation enhanced the rate and time to union. Fractures treated with early open reduction and internal fixation, excluding Group III patients, had the least orthopedic and medical complications. Open reduction and internal fixation is a justifiable alternative to nonoperative treatment in the uncomplicated tibia fracture regardless of neurologic lesion for improved medical and fracture care.
在28例急性脊髓损伤患者的34处胫骨骨折中，13例患者有完全性神经损伤，15例有不完全性神经损伤。胫骨骨折分为三组：第一组，非手术治疗；第二组，早期切开复位内固定；第三组，Ⅲ型开放性损伤。第一组包括17处骨折，其中9处（53%）发生了延迟愈合、畸形愈合或骨不连。平均愈合时间为6.5个月。7例患者出现了压疮和肺栓塞。第二组有11处骨折。出现1例延迟愈合（9%）、1例浅表伤口感染且顺利愈合以及1例深静脉血栓形成。平均愈合时间为12周。第三组的所有6处胫骨骨折均发生了延迟愈合和骨不连，无论采用何种治疗方法。非手术治疗的骨折愈合速度较慢，而切开复位内固定则提高了愈合速度和缩短了愈合时间。对于不包括第三组患者的胫骨骨折，早期切开复位内固定治疗的骨科和内科并发症最少。在不复杂的胫骨骨折中，无论神经损伤情况如何，切开复位内固定是比非手术治疗更合理的选择，有助于改善内科治疗和骨折处理。
