带锁髓内钉静力型固定延期动力化治疗胫骨多段骨折.DOCVIP

临床医学论文-带锁髓内钉静力型固定延期动力化治疗胫骨多段骨折 ????????????????????? 作者：冯斌 张震 胡宗凯 李波 王旨 钟波 【摘要】目的? 探讨带锁髓内钉静力型固定延期动力化治疗胫骨多段骨折的临床疗效。方法? 2003年1月-2008年12月采用带锁髓内钉静力型固定延期动力化治疗胫骨多段骨折22例，其中男15例，女7例，年龄18岁-65岁。闭合性骨折8例，开放性骨折14例。结果? 术后随访12-36个月，平均随访18个月，骨折全部愈合，平均愈合时间20周。关节功能按Johner-Wruhs评分标准：优18例，良4例。结论? 带锁髓内钉静力型固定延期动力化治疗胫骨多段骨折具有早期固定坚强、术后可早期活动、骨折愈合率高等优点，是治疗胫骨多段骨折较为理想的内固定治疗方法。【关键词】静力型带锁髓内钉? 延期动力化? 胫骨多段骨折【Abstract】Objective: To evaluate the clinical effect of static interlocking intramedullary nail delayed dynamic in the treatment of segmental fracture of the tibia. Methods: From January 2003 to December 2008, 22 patients with segmental tibia fractures were treated with static interlocking intramedullary nail delayed dynamic. Of the patients, 15 cases were male and 7 female, aged ranging from 18 to 65 years old. Closed fractures were 8 cases and open fractures were 14 cases. Results: All patients followed up period were 12 months?6 months ,with an average 18 months. All fractures were completed healed. The period of fracture union averaged 20 weeks. According to Johner-Wruhs’s criterion, the results of the treatment were evaluated as excellent in 18 patients, good in 4 patients. Conclusion: Static interlocking intramedullary nail delayed dynamic is the better method for treatment segmental tibia fractures. It has the advantages of stable fixation in early period, early exercise and high rate of fracture healing.【Key words】Static interlocking intramedullary nail? Delayed dynamic? Segmental tibia fracture??????? 我们在2003年1月～2008年12月采用带锁髓内钉静力型固定延期动力化治疗胫骨多段骨折22例，取得了较为满意的疗效。现报告如下。??????? 1? 临床资料??????? 1.1? 一般资料??????? 本组22例，其中男15例，女7例，年龄18岁-65岁，平均38.5岁，左侧13例，右侧9例；闭合性骨折8例，开放性骨折14例，均为新鲜骨折。开放性骨折按Gustilo分类：Ⅰ型4例，Ⅱ型7例，Ⅲa型3例。致伤原因：车祸19例，重物砸伤2例，高处坠落伤1例。合并症：多发性骨折5例，腰椎骨折2例，颅脑损伤3例，胸腹部损伤4例。合并其他损伤者先由相关科室处理，病情平稳后转入我科处理骨折。开放性骨折Ⅰ型行急诊手术内固定，开放性骨折Ⅱ型及Ⅲa型入院急诊行清创并跟骨牵引，二期行内固定术，闭合性骨折行骨牵引7-10天后手术。??????? 1.2? 手术方法??????? 全麻或硬膜外麻醉，仰卧位，常规气囊止血带下手术。开放性骨折常规再次清创后扩大原切口显露骨折端，闭合性骨折取小腿前外侧切口，显露多个骨折段，仅在骨折端剥离骨膜（满足复位即可）。复位后，用小钢板结