Court-Brown C M, Keating J F, Christie J, McQueen M M
Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh NHS Trust, UK.
J Bone Joint Surg Br. 1995 May;77(3):407-11.
Exchange nailing for failure of union after primary intramedullary nailing of the tibia is widely used but the indications and effectiveness have not been reported in detail. We have reviewed 33 cases of uninfected nonunion of the tibia treated by exchange nailing. This technique was successful without open bone grafting in all closed fractures and in open fractures of Gustilo types I, II and IIIa. The requirement for open bone grafting was reduced in type-IIIb fractures, but exchange nailing failed in type-IIIb fractures with significant bone loss. For these we recommend early open bone grafting. The most common complication was wound infection, seen more often than after primary nailing. We discuss our protocol for the use and timing of exchange nailing of all grades and types of tibial fracture.
在胫骨初次髓内钉固定术后骨不连时采用更换髓内钉的方法应用广泛，但有关其适应证及疗效的详细报道尚不多见。我们回顾性分析了33例采用更换髓内钉治疗的胫骨未感染性骨不连病例。该技术在所有闭合性骨折以及Gustilo Ⅰ型、Ⅱ型和Ⅲa型开放性骨折中均无需切开植骨即获成功。Ⅲb型骨折切开植骨的需求有所减少，但在伴有大量骨质缺损的Ⅲb型骨折中更换髓内钉失败。对于此类骨折，我们建议早期切开植骨。最常见的并发症是伤口感染，其发生率高于初次髓内钉固定术后。我们讨论了针对所有分级和类型胫骨骨折更换髓内钉的使用方案及时机。
