交锁钉治疗胫腓骨多段骨折体会.docVIP

交锁钉治疗胫腓骨多段骨折体会【摘要】 目的 评价交锁钉对胫骨干多段骨折的治疗效果。方法 回顾分析2005~2010年以来应用交锁钉治疗胫骨干多段骨折32例，观察术后1年的恢复情况。结果 交锁钉治疗骨折原位愈合率为91%(29/32)，成角畸形愈合率3%(1/32)，骨折延迟愈合6%(2/32)，骨不连0例，骨髓炎3%(1/32)，皮瓣坏死6%(2/32)，筋膜间隙综合征0例。平均骨折愈合时间7.5个月。结论 交锁髓内钉治疗胫骨干多段骨折生物力学好、操作方便、固定牢固、对骨折局部软组织血供损伤小、张力小，故骨折局部软组织并发症少、感染率低，其治疗效果好，值得推广。 【关键词】 胫骨多段骨折；骨折内固定术；交锁钉 Experience of interlocking nailing in treatment of tibia fracture CHEN Jian-guo. The Third People?s Hospital of Datong Coal Industry Group in Shanxi Province,Shanxi 037017,China 【Abstract】 ObjectiveTo evaluate effects of interlocking nailing in treatment of tibial multi-segmental fracture. Methods 32 cases of interlocking nailing in treatment of tibial multi-segmental fracture during 2005 to 2010 were reviewed and analyzed and observed the recovery condition 1 year after the operation. Results The recovery rate of interlocking in fracture group treatment was 91%(29/32), the recovery rate of angular deformity was 3%(1/32), delayed fracture recovery rate was 6%(2/32), 0 case of bone disconnection, 3% of osteomyelitis(1/32),6% of skin flap necrosis(2/32), 0 case of fascial space syndrome. The average fracture recovery period was 7.5 months. Conclusion Interlocking intramedullary nailing has fine biomechanics, convenient operation, solid fixation, less trauma on regional soft tissue of the fracture and less tension: hence less complications of the fractured regional soft tissue and lower infection rate. It is effective in treatment and worthy of extending. 【Key words】 Tibial multi-segmental fracture; Internal fixation of fracture;Interlocking nailing 胫骨干多段骨折因骨折部位位于皮下，软组织挫伤严重，肌肉覆盖少，血供差，易发生局部皮瓣坏死、骨筋膜间隙综合征、骨髓炎、骨折延迟愈合、骨不连等并发症，是临床治疗的一大难题。我科自2005~2010年分别采用GK交锁钉治疗胫骨干多段骨折32例,效果良好。现报告如下。 1 资料与方法 1.1 一般资料 本组病例32例，年龄19~58岁，平均33.5岁。男26例，女6例。闭合性21例，占65.5%，开放性11例，占34.5%。受伤原因：煤矿事故伤17例，交通事故伤11例，高处坠落伤1例，砸伤3例。合并其他肢体骨折7例，并发创伤性休克3例。 1.2 治疗方法 26例采用硬膜外麻醉，6例采用全麻；32例患者分别在伤后5 h~21 d 手术，平均8.5 d，其中急诊手术11例，均为开放性骨折；21例行跟骨持续牵引，待伤肢消肿后，二期髓内钉固定。其中23例采用小切口开放式辅助复位，9例使用C型臂X线机