Jenny J Y, Jenny G, Gaudias J, Kempf I
Centre de Traumatologie et d'Orthopédie, Strasbourg, France.
Acta Orthop Belg. 1995;61 Suppl 1:212-5.
Intramedullary reamed locking nail of open fractures remains controversial because of the risk of infection. 1,474 closed reamed locked nailings were performed between 1974 and 1989 for femoral (744 cases) or tibial (730 cases) fractures. 349 fractures were open: 100 femoral fractures (51 Gustilo and Anderson Grade I and 49 Grade II) and 249 tibial fractures (140 Grade I, 99 Grade II et 10 Grade III). 24 femoral (3.2%) and 46 tibial (6.3%) nails were followed by infection. This difference is significant (p < 0.01). Reoperations for infection occur more frequently for femoral than tibial fractures (p < 0.05). There is no difference between the results of infection treatment between femoral or tibial fractures. Traumatic opening of the femoral fracture site does not affect the occurrence of an infection, its severity or the results of its treatment. Traumatic opening of the tibial fracture site significantly increases the infection rate (p < 0.001), and the incidence of infection increases with the severity of the soft tissue lesions; but the severity of the infection and the results of its treatment are not modified. Acute closed reamed intramedullary locking nail is the best treatment for open femoral or tibial fractures with respect to the bone healing and infection rate for Grade I and II fractures. For Grade III fractures, nailing must be followed by a coverage flap.
由于存在感染风险，开放性骨折的髓内扩髓锁定钉治疗仍存在争议。1974年至1989年间，共对744例股骨骨折和730例胫骨骨折进行了1474例闭合性扩髓锁定髓内钉固定术。其中349例为开放性骨折：100例股骨骨折（51例为Gustilo和Anderson I级，49例为II级）和249例胫骨骨折（140例为I级，99例为II级，10例为III级）。24例股骨（3.2%）和46例胫骨（6.3%）的髓内钉术后发生感染。这种差异具有统计学意义（p < 0.01）。股骨骨折术后因感染进行再次手术的频率高于胫骨骨折（p < 0.05）。股骨或胫骨骨折感染治疗的结果无差异。股骨骨折部位的创伤性开放不影响感染的发生、严重程度或治疗结果。胫骨骨折部位的创伤性开放显著增加感染率（p < 0.001），且感染发生率随软组织损伤严重程度增加而升高；但感染的严重程度及其治疗结果不受影响。对于I级和II级开放性股骨或胫骨骨折，就骨愈合和感染率而言，急性闭合性扩髓髓内锁定钉是最佳治疗方法。对于III级骨折，髓内钉固定后必须进行皮瓣覆盖。
