Riemer B L, Miranda M A, Butterfield S L, Burke C J
Department of Orthopaedic Surgery, Allegheny General Hospital, Medical College of Pennsylvania, Pittsburgh, USA.
Clin Orthop Relat Res. 1995 Nov(320):119-24.
A retrospective comparison of dynamic and static locking mode nonreamed nails in 88 closed, Grades I and II open tibial fractures is presented. Amount of time and number of reoperations required to unite fractures were compared for dynamic (Group 1, n = 31) and static locked (Group 2, n = 13) Winquist I and II fractures, and dynamic (Group 3, n = 14) and static locked (Group 4, n = 30) Winquist III, IV, and segmental fractures. Total reoperations also were compared; Tibias treated with dynamic nails united in an average of 20 weeks, with 3 reoperations; tibias treated with static locked nails united in an average of 30 weeks, with 21 reoperations. Group 1 fractures united in an average of 20 weeks, with 1 reoperation; Group 2 fractures united in an average of 32 weeks, with 4 reoperations. Group 3 fractures united in an average of 20 weeks; Group 4 fractures united in an average of 29 weeks, with 11 reoperations. In the group of tibias treated with dynamic nails, 3 additional operations were done; in the group of tibias treated with static locked nails, 7 additional operations were done. There was 1 infection and 3 deformities. Static locking mode appeared to delay union, especially when Groups 1 and 2 are compared; these fractures can be nailed without locking screws.
本文对88例闭合性、I级和II级开放性胫骨骨折采用动力型和静力型锁定髓内钉进行回顾性比较。比较了动力型（第1组，n = 31）和静力锁定型（第2组，n = 13）Winquist I级和II级骨折以及动力型（第3组，n = 14）和静力锁定型（第4组，n = 30）Winquist III级、IV级和节段性骨折愈合所需的时间和再次手术次数。还比较了总的再次手术情况；采用动力型髓内钉治疗的胫骨平均20周愈合，需再次手术3次；采用静力锁定型髓内钉治疗的胫骨平均30周愈合，需再次手术21次。第1组骨折平均20周愈合，需再次手术1次；第2组骨折平均32周愈合，需再次手术4次。第3组骨折平均20周愈合；第4组骨折平均29周愈合，需再次手术11次。在采用动力型髓内钉治疗的胫骨组中，额外进行了3次手术；在采用静力锁定型髓内钉治疗的胫骨组中，额外进行了7次手术。发生1例感染和3例畸形。静力锁定模式似乎延迟了骨折愈合，尤其是比较第1组和第2组时；这些骨折可以不使用锁定螺钉进行髓内钉固定。
