交锁髓内钉治疗胫骨中远段开放性骨折

摘要

Objective To explore clinical outcome of the treatment on open tibial middle and distal segment fractures of interlocking intramedullary nails and anatomical type tibial nails by using of reamed technology.Methods A retrospective review of 36 patients suffering tibial distal segment of open fractures accepting interlocking intramedullary nail fixation from May 2008 to May 2011 in our hospital. Reamed technology was uesd for all patients . There were 21 males and 15 females, aged 20-65 years old. 15 cases were suffering left side, the right side is 21 cases.12 cases were with fibula fractures, and 6 patients were tibia multiple fractures, All of them did not involve the far end load articular surface. According to the AO/ASIF classification, 42A type was 10 cases,42B 12 cases, 42C 6 cases, and 43A 8 cases. According to the Gustilo classification, 16 cases of type I and 20 type II. Results Cases were followed up for 6 to 18 months, 1 case did not heal after14 months , others had achieved good clinical curative effect.All cases had no fracture malunion, no postoperative infection, No broken locking screws. Average healing time 18 weeks. Conclusion Application of traditional tibial interlocking intramedullary nail and anatomical type tibial nails in the treatment of tibial fractures of distal segment of open fractures, by using reamed technology is conforming to the fracture internal fixation requirements.Reamed technology did not increase the risk of infection.The effect is ideal.%　　目的探讨利用扩髓技术，应用传统交锁髓内钉及解剖型胫骨钉治疗胫骨中远段开放性骨折的疗效。方法回顾本院2008年5月至2011年5月行交锁髓内钉内固定手术的36例胫骨中远段开放性骨折病例。均使用扩髓技术。其中男21例，女15例，年龄20～65岁。左侧为15例，右侧为21例，合并腓骨骨折12例，胫骨多段骨折为6例，均未累及远端负重关节面。按AO/ASIF分类，42A型10例，42B型12例，42C型6例，43A型8例。按Gustilo分型，为I型16例，II型20例。结果术后随访6-18个月，其中1例术后超过14个月未愈合，余均取得良好的临床疗效。无骨折畸形愈合，无术后感染，锁钉未发现断钉现象。骨折平均愈合时间18周。结论应用传统胫骨交锁髓内钉及解剖型胫骨钉治疗胫骨中远段开放性骨折骨折，使用扩髓技术，符合骨折内固定要求，扩髓未增加感染风险，效果理想。