带锁髓内钉内固定治疗胫骨骨折的体会 胫骨骨折髓内钉固定术

带锁髓内钉内固定治疗胫骨骨折的体会 胫骨骨折髓内钉固定术 摘要 目的 探讨带锁髓内钉内固定术治疗胫骨骨折的临床效果。 方法 回顾性分析xx年1月xx年12月本院应用C臂透视下闭合复位加带锁髓内钉内固定治疗胫骨骨折并随防182例患者的临床资料。 结果 所有随访病例均在48个月实现临床愈合，关节功能正常，无感染、畸形、脂肪栓塞及骨筋膜室综合征发生，按Johner-Wruhs功能恢复标准：优160例，良22例。 结论 带锁髓内钉治疗胫骨骨折具有创伤小、固定可靠、骨折愈合率高、能早期活动、感染率低等优点，可作为治疗胫骨骨折的内固定方法。 关键词 带锁髓内钉内固定术；胫骨骨折；临床疗效；愈合率 R687.3 B 1674-4721（xx）07（c）-0253-02 Experience of interlocking intramedullary nail fixation in the treatment of tibial fracture LIU Wanxin LIU Rixin CHEN Xuanming LI Chunxiao Department of Orthopedics, Affiliated Chenxinghai Hospital of Guangdong Medical College in Guangdong Province, Zhongshan 528415, China Abstract Objective To investigate the clinical efficacy of interlocking intramedullary nail fixation in the treatment of tibial fractures. Methods The clinical data of one hundred and eighty-two cases of patients with tibial fracture treated with closed reduction under C arm fluoroscopy and interlocking intramedullary nail fixation in our hospital from January xx to December xx were analyzed retrospectively. Results All the cases were cured in 4 to 8 months, the joint function was normal, had no incidence of infection, deformity, fat embolism and osteofascial partment syndrome. Aording to the Johner-Wruhs function recovered standard, one hundred and sixty cases were excellent, twenty-two cases were good. Conclusion Intramedullary interlocking nail in the treatment of tibial fractures has advantages of small trauma, reliable fixation, high fracture healing rate, early activity and low infection rate, which can be used as the internal fixation method in the treatment of tibial fracture. Key words Interlocking intramedullary nail internal fixation; Tibial fracture; Clinical efficacy; Healing rate 胫骨骨折是长管状骨折中最为常见的一种疾病，占全身骨折的13.7%1。由于胫骨表面肌肉及软组织覆盖少及血液供应欠佳，尤其是胫骨中下段，致使骨折不愈合或延迟愈合率高，而采用骨折闭合复位带锁髓内钉内固定后疗效明显提高。本院从xx年1月xx年12月应用髓内钉内固定治疗胫骨骨折182例，现报道如下： 1 资料与方法 1.1 一般资料 本组患者182例，其中，男101例，女81例，年龄1965岁，平均36岁；胫腓骨双骨折42例，胫骨骨折140例；闭合骨折156例，开放骨折26例；受伤原因：交通事故受伤113例，摔伤43例，坠落伤12例，重物压伤14例；AO分型：A型98例，B型63例，C型21 例；受伤至手术时间为2 h7 d，平均3 d。 1.2 手术方法 硬膜外麻醉后，患者采取仰卧位，上气压止血带，屈髋80，屈膝100。切口选至髌腱内侧纵行长约5.0 cm，切开皮肤、皮下组织，将髌腱向外侧牵开，显露胫骨结节，在胫骨平台与胫骨结节中点用三棱骨锥沿胫骨纵轴钻孔，直到胫骨髓腔。先从8 mm扩髓器扩髓，扩至髓腔最狭窄处，置入比扩髓器小一号的髓内钉，牵引闭合复位；复位困难者则在骨折端作一小切口，用C臂透视见骨折端及髓内钉位置良好后，拔出导针，将定位杆定位好，经远端钉瞄准器由内向外锁入2枚锁钉，带锁髓内主钉须回敲骨折端使其稍有嵌插，有利于骨折部位紧密接触，促进骨折愈合；在近端经近端瞄准器锁入2枚锁钉，最后安上钉尾螺帽，若有腓骨骨折再行腓骨内固定，切口逐层缝合，手术完毕。 1.3 术后处理 手术后使用抗生素13 d，并抬高患肢，若肿胀明显，静滴