一期应用交锁髓内钉及-或AO外固定架治疗双侧胫骨骨折.docVIP

一期应用交锁髓内钉及/或AO外固定架治疗双侧胫骨骨折 　【摘要】 　　［目的］探讨一期应用交锁髓内钉和／或AO外固定架治疗双侧胫骨骨折的临床价值和相关问题。［方法］回顾性分析自1998年4月～2006年1月间一期应用交锁髓内钉和／或AO外固定架治疗双侧胫骨骨折33例66肢。男26例，女7例；平均34.4岁。闭合骨折按AO／ASIF分型：A型9肢；B型13肢；C型17肢。开放骨折按Gustio分型：I型10肢；Ⅱ型6肢；ⅢA型5肢；ⅢB型4肢；ⅢC型2肢。受伤至手术时间平均为5.5 d(3 h～12 d)。［结果］随访6个月～3年，平均16个月。66肢均达骨性愈合，骨折平均愈合时间：闭合性骨折16周，开放性骨折18周，4肢延迟愈合。3肢发生浅表感染经保守治疗痊愈。按JohnerWruh评分标准，结果：优19例，良11例，可3例。优良率为90.9％。无脂肪栓塞综合征、深部感染，内固定失效及畸形愈合发生。［结论］一期应用交锁髓内钉和／或AO外固定架治疗双侧胫骨骨折操作简单，骨折端血运破坏少，固定确切，骨折愈合率高，可早期功能锻炼且疗效满意。固定方式应根据骨折类型选择最佳方法。 【关键词】 交锁髓内钉 外固定架 胫骨骨折 治疗结果 　　Surgical treatment of bilateral tibial fracture with interlocking intramedullary nail and/or AO external fixator∥ 　　Abstract：［Objective］To evaluate the clinical value and relating problems in treating bilateral tibial fracture by using interlocking intramedullary nail and/or AO external fixator.［Method］Totally 33 patients of bilateral tibial fracture treated with interlocking intramedullary nail and/or AO external fixator from April 1998 to January 2006 were retrospectively reviewed.There were 26 males,7 females,with an average age of 34.4 years.According to the AO/ASIF classification,there were type A 9 limbs,type B 13 limbs and type C 17 limbs.According to Gustilo classification there were type Ⅰ 10 limbs,type Ⅱ 6,ⅢA 5,type ⅢB 4 and type ⅢC 2.Duration from injury to operation was 5.5 days(3 hour～12 days). ［Result］All patients were followed up for 6～36 months,with the average time being 16 months.All fractures had bon union.The union time averaged 16 weeks in closed fractures and 18 weeks in open fractures.Delayed union occurred in 4 limbs.There were 3 limbs of superficial infection.The results were excellent in 19 cases,good 11 cases,fair 3 cases according to the criteria of JohnerWruh.Rate of excellent and good result was 90.9%.No fat embolism syndrome,deep in fection,failure of fixation and malunion were not found in this group.［Conclusion］The advantages of interlocking intramedullary nail and /or AO external fixator in treatment of bilateral ti