Runkel M, Wenda K, Degreif J, Blum J
Klinik und Poliklinik für Unfallchirurgie, Johannes-Gutenberg-Universität Mainz.
Unfallchirurg. 1996 Oct;99(10):771-7. doi: 10.1007/s001130050054.
Primary stabilization was performed in 72 tibial fractures with sever open (n = 37) or closed (n = 35) soft tissue injury using unreamed interlocking nails. In 60 (83%) cases the fractures healed without additional procedures. There were 2 cases of osteitis, but both these fractures healed after removal of the nail or after reamed nailing. In 9 patients with delayed union reamed nailing (n = 8) or bone grafting (n = 1) led to healing. In 1 patient with hypertrophic pseudarthrosis, union was achieved after substitution of a reamed nail for the anreamed nail. The infection rate was similar to that observed with external fixation. More secondary procedures, such as bone grafting or a change of the osteosynthesis technique, are necessary with external fixation than with unreamed nailing. Further advantages of unreamed nailing are the internal treatment of the fracture and the patient's greater comfort. Therefore, unreamed nailing can be recommended for the primary treatment of tibial fractures with severe open or closed soft tissue trauma.
采用非扩髓带锁髓内钉对72例伴有严重开放性（n = 37）或闭合性（n = 35）软组织损伤的胫骨骨折进行了一期固定。60例（83%）患者骨折愈合，无需额外手术。有2例发生骨髓炎，但这2例骨折在取出髓内钉或扩髓后均愈合。9例骨折延迟愈合患者，经扩髓髓内钉固定（n = 8）或植骨（n = 1）后骨折愈合。1例肥大性假关节患者，将非扩髓髓内钉更换为扩髓髓内钉后骨折愈合。感染率与外固定相似。与非扩髓髓内钉固定相比，外固定需要更多的二次手术，如植骨或改变骨固定技术。非扩髓髓内钉固定的其他优点是骨折的内固定治疗以及患者舒适度更高。因此，对于伴有严重开放性或闭合性软组织创伤的胫骨骨折的一期治疗，推荐采用非扩髓髓内钉固定。
