Gustilo-Ⅲb型胫骨干开放性骨折使用带锁髓内钉固定的可行性探讨

摘要

目的：探讨 Gustilo-Ⅲ b 型胫骨干开放性骨折使用带锁髓内钉固定的可行性。方法：63例Ⅲ b 型开放性胫骨干骨折采用带锁髓内钉治疗32例，单侧外固定支架治疗31例。结果：随访10~24个月（平均16.6个月），两组深部感染率和骨不连发生率差异无统计学意义（P>0.05），外固定支架组畸形愈合率高，髓内钉组膝踝关节功能优良率高，最终结果评定髓内钉组优于外固定支架组（P<0.05）。结论：在Ⅲ b 型胫骨干开放性骨折中，使用髓内钉固定是可行的，比外固定支架有优势，只要骨折的形态适于髓内钉固定，就应该首选髓内钉。%Objective:To investigate the clinical effect of Gustilo- Ⅲ b open tibial fractures with the use of interlocking nailing.Method:32 patients with Gustilo- Ⅲ b tibial fractures were treated by interlocking nailing,31 patients used unilateral external fixator.Result:The patients were followed up for 10 to 24 months(mean 16.6 months),There were no significant differences in the rate of deep infection and nonunion between the two groups,The rate of malunion was higher than the external fixation group,The excellent to good rate for function of the knee and ankle joints was higher than the interlocking nailing group,The final result evaluation of the interlocking nailing group was superior to the external fixation group.Conclusion:Compared with external fixation,we consider that locked nailing is the treatment of choice for Gustilo- Ⅲ b open tibial fractures.As long as the fracture morphology is suitable for interlocking nailing,should be preferred interlocking nailing.