摘要
目的 分析比较带锁髓内钉与钢板内固定治疗长管骨骨折的优缺点。方法 将在我院接受内固定治疗的 18岁以上的肱骨、股骨、胫骨三大长管骨骨折 4 33例作回顾性分析。其中带锁髓内钉固定组 191例 ,钢板内固定组 2 4 2例。平均随访 36 5个月。对二组的术前一般情况、术中创伤、术后骨折愈合时间、并发症及功能恢复情况作比较分析。结果 带锁髓内钉组固定强度大可早期负重 ,功能恢复好。但由于对髓内血供的破坏 ,术后出现骨痂时间 (平均 3 89个月 )和骨折完全愈合时间 (平均 15 4 3个月 )较对照组术后出现骨痂时间 (平均 3 2 3个月 )和骨折完全愈合时间 (平均 9 92个月 )迟。统计学分析差异有显著性 (P <0 0 5 )。而闭合复位带锁髓内钉固定的病例出现骨痂时间 (平均 2 73个月 )和骨折完全愈合时间 (平均 12 12个月 ) ,明显早于切开复位内固定者。结论 带锁髓内钉固定切开复位时髓内及髓外血供都要破坏 ,电动扩髓产热引起内侧皮质骨坏死 ,将影响骨折愈合 ,且骨髓炎及骨不连的风险较大。因此带锁髓内钉尽量作闭合复位或微小切开复位。
Objective To analyze and compare the advantage and disadvantage of treatment of the long bone shaft fracture with intramedullar interlocking nail and plate.Methods Four hundred and thirty-three cases of long bone shaft fracture of humerous, femur and tibia were reviewed and analyzed. Among them, 191cases were treated with intramedullar interlocking nail,and 242 cases were treated with plate internal fixation, two teams were compared and analyzed through the general condition, operation wound, the time of fracture healing, complications and the function recovery.Results The average followed-up period was 36 5 months (9 months～5 years ). It is discovered that the strength of the intramedullar interlocking nail fixation was hard to bear weight early,and the function was recovered well. But, because of the destruction of intramedullar blood supply, the time of callus appearing after operation (average 3 89 months) was later than that from the normal group (average 3 23 months); the time of fracture healing (average 15 43 months) was later than that from the normal group (average 9 92 months). There was significant difference(p<0 05) between them at statistics. But for the cases of intramedullar interlocking nail fixation,the time of callus appearing (average 2 93 months) and the time of fracture healing(average 12 12 months) with closed reduction were earlier than those of the cases with open reduction.Conclusion The open reduction of intramedullar interlocking nail fixation destroyed the blood supply of intramedullar and extramedullar, the marrow cavity rasping generating the heat caused the necrosis of the interior compact tissue, and this influenced fracture healing, and the probability of osteomyelitis and disunion greatly increased. So the closed reduction and minute incision reduction should be adoptted in intramedullar interlocking nail fixation.
出处
《骨与关节损伤杂志》
2002年第4期283-285,共3页
The Journal of Bone and Joint Injury
关键词
带锁髓内钉
钢板
内固定
长管骨骨折
疗效
Intramedullar interlocking nail
Plate
Internal fixation
Long bone shaft fracture
Analysis of effect
