目的 探讨胫腓骨骨折内固定物的选择与并发症的防治.方法 33例胫腓骨骨折患者,上下1/3骨折采用内或外侧切开复位解剖钢板内固定,伴有腓骨骨折者同时切开复位管状钢板内固定;中1/3骨折选用交锁髓内钉内固定;开放性骨折急诊清创待伤口愈合后再行钢板内固定.结果 33例患者骨折均临床愈合,时间4～6个月.有1例锁钉断裂,1例锁钉钉眼有脓性分泌物,2例皮瓣坏死,1例踝背屈较健侧差约10°.结论 胫骨中1/3骨折选用交锁髓内钉,上下1/3选用解剖钢板内固定是合适的,开放性骨折清创后延期钢板内固定.钢板内固定应在局部肿胀消退后进行.%Objective To explore the selection of internal fixation and prevention and treatment of complications for tibial and fibu- lar fractures. Methods 33cases of tibial and fibular fractures were stabilized by anatomical plates and interlocking intramedullary nails dur-ing January 2001 to june 2007, 1/3 proximal and distal segment tibial fractures were treated by open reduction and fixated with anatomical plates or by open reduction and fixated with tubular plates if complicated with fibula fractures, ,. 1/3 middle segment of tibial fractures were fixated with interlocking intramedullary nails. Open fractures of tibia were debrided urgently and they were fixated with plates after the wounds healed. Results The fractures of 33 cases achieved clinical healing after 4～6 months. However,a case had interlocking intramedullary nail breakage after operation ;one case had purulent secretions in the hole of interlocking intramedullary nail ;2 cases had flap necrosis;one patient 's ankle dorsiflexion was about 10 degrees less than that of uninjured side. Conclusion The anatomical plates can be effectively used for fractures of 1/3 proximal and distal segment tibia. The fractures fixation with interlocking intramedullary nails should be the first choice for 1/3 middle segment of tibial fractures. Open fractures of tibia should be postponed fixated with plates atfer debridement. The tibial and fibular fractures should be stabilized by plates after local swelling subsided.
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