Melcher G A, Ryf C, Bereiter H, Leutenegger A, Rüedi T
Chirurgische Klinik, Rätisches Kantons- und Regionalspital Chur.
Schweiz Med Wochenschr. 1993 Apr 3;123(13):587-8.
It is generally accepted that intramedullary nailing in combination with reaming should be avoided in treating open fractures. However, the use of an unreamed, solid nail combined with interlocking also allows stabilization of open and complex fractures. 20 tibia fractures (65% open, 45% complex fractures) have been treated by the AO unreamed tibial nail (UTN), 12 (5 of them open fractures) by direct nailing and 8 after initial stabilization by an external fixator. In our series no intraoperative complications, no soft-tissue healing problems and no infections occurred. Thus, treatment of both open and comminuted fractures by UTN appears to be safe and generally needs no secondary stabilization.
一般认为，治疗开放性骨折时应避免使用扩髓髓内钉。然而，使用不扩髓的实心钉并结合交锁也可稳定开放性和复杂骨折。20例胫骨骨折（65%为开放性骨折，45%为复杂骨折）采用AO不扩髓胫骨髓内钉（UTN）治疗，12例（其中5例为开放性骨折）采用直接髓内钉固定，8例在使用外固定架初步稳定后进行治疗。在我们的系列病例中，未发生术中并发症、软组织愈合问题及感染。因此，UTN治疗开放性骨折和粉碎性骨折似乎是安全的，一般无需二次固定。
