交锁髓内钉治疗胫骨干长节段粉碎性骨折

目的：阐明交锁髓内钉内固定治疗胫骨干多节段粉碎性骨折的优越性和手术要点。方法：分析2000年6月-2004年12月26例胫骨干长节段粉碎性骨折使用交锁髓内钉固定的疗效和手术注意事项。手术采用闭合穿钉。有限切开复位．部分钢丝捆绑复位碎骨块．再用瞄准器镇定骨折远、近端。结果：26例均获得随访，随访平均时间16．5个月（6-60个月）。远期疗效按马元璋评定标准：优13例．良10例．可3例．优良率88．5％（23／26）．平均骨临床愈合时间5．5月．一期骨折愈合率达到80．8％（21／26）。仅1例髓内钉发生锁钉断裂。无深部感染、骨髓炎、畸形愈合、骨不连的发生。结论：交锁髓内钉治疗胫骨干长节段粉碎性骨折较钢板有着微刨和更符合胫骨生物力学等优越性。本组骨折愈合率高．并发症少。认为是目前治疗胫骨干长节段粉碎性骨折的首选方法。

THE TREATMENT OF TIBIAL LONG - FRAGMENT SHAFT FRACTTURES BY INTER - LOCKING NAIL

Objective:To explore the superiority and the bey of operation of interlocking nail with tris-dimension aim im- plement in treating tibial shaft long-fragment fractures.Method:Twenty-six cases of shaft comminuted fratures treated with in- ter-locking nail by static locking were reviewed.The comminuted fractures with diffcult reduction was local opened with a limited incision,and the two sides of the fracture were locked with nalils by an aim implement.Results:All cases were followed up (aver- age 16.5 months).Long term effect was evaluated by MaYuanzhang evaluation standard:13 cases gained exellent clinical results, 10 good,3 fair,excellent rates were 88.5 percent (23/26).Average period of fracture healing was 5.5 months,and 80.8 per- cent (21/26) showed concrescence of fracture.Only 1 cases was founded with interlocking-nail rupture.Conclusion:Inter-lock- ing nail is a principal way in breating tibial shaft long-fragment fractures because of its microtauma and its coincidence with the tib- ial biomechanics enviroment when comparied with steel-plate.