CAJ | 학술논문

目的评价超远端胫骨髓内钉治疗开放性或潜在开放性(Tscherne分型为2度、3度)的胫骨远端干骺端骨折的安全性与有效性.方法 2007年3月至2008年4月共收治15例胫骨远端骨折患者,男9例,女6例;年龄21～53岁,平均34.3岁.对于Gustilo Ⅰ型、Ⅱ型开放性骨折患者,于伤后6～48 h采用超远端胫骨髓内钉治疗;对于Gustilo Ⅲ型开放性骨折患者,将该髓内钉作为分期治疗策略中的最终治疗.对于闭合性骨折患者,先予消肿抗炎等对症处理,待肢体皮肤褶皱出现、局部软组织无红肿渗液时手术.通过随访患者影像学资料及术后1年Johner-Wruhs评分标准评估其临床疗效.结果 15例患者术后获12～18个月(平均14个月)随访;骨折愈合时间为18～25周(平均21.1周),所有患者均获解剖或功能复位.术后1年根据Johner-Wruhs评分标准评价疗效:优11例,良3例,可1例,优良率为93.3%.并发症:伤口浅层感染3例,皮肤局部坏死2例,经清创换药后愈合.未发生深部及髓内感染,无畸形愈合或不愈合发生.结论对于开放性及潜在开放性胫骨远端干骺端骨折,超远端胫骨髓内钉是一种安全、有效的选择.
목적 평개초원단경골수내정치료개방성혹잠재개방성(Tscherne분형위2도、3도)적경골원단간후단골절적안전성여유효성.방법 2007년3월지2008년4월공수치15례경골원단골절환자,남9례,녀6례;년령21～53세,평균34.3세.대우Gustilo Ⅰ형、Ⅱ형개방성골절환자,우상후6～48 h채용초원단경골수내정치료;대우Gustilo Ⅲ형개방성골절환자,장해수내정작위분기치료책략중적최종치료.대우폐합성골절환자,선여소종항염등대증처리,대지체피부습추출현、국부연조직무홍종삼액시수술.통과수방환자영상학자료급술후1년Johner-Wruhs평분표준평고기림상료효.결과 15례환자술후획12～18개월(평균14개월)수방;골절유합시간위18～25주(평균21.1주),소유환자균획해부혹공능복위.술후1년근거Johner-Wruhs평분표준평개료효:우11례,량3례,가1례,우량솔위93.3%.병발증:상구천층감염3례,피부국부배사2례,경청창환약후유합.미발생심부급수내감염,무기형유합혹불유합발생.결론 대우개방성급잠재개방성경골원단간후단골절,초원단경골수내정시일충안전、유효적선택.
Objective To evaluate the safety and efficacy of extra-distal tibial intramedullary nailing for open and potentially open fractures of distal metaphyseal tibia.Methods Between March 2007 and April 2008, 15 patients (9 men and 6 women), with a mean age of 34.3 (from 21 to 53) years, were admitted to this study.For Gustilo Ⅰ and Ⅱ fractures, extra-distal tibial intramedullary nailing was performed 6 to 48 hours after injury; for Gustilo Ⅲ fractures, the intramedullary nailing was conducted as the definitive procedure of a staged strategy; for closed fractures, the operation was not performed until swelling subsided and exudation stopped following symptomatic treatments.All the patients were followed up by periodic X-ray examination.Functional outcomes were evaluated according to Johner-Wruhs criteria one year after surgery.Results The patients obtained a mean follow-up of 14 months (range, 12 to 18) after surgery.Anatomic or functional reduction was achieved and maintained in all the cases.The fractures healed 21.1 weeks (range,18 to 25) after surgery.By Johner-Wruhs criteria, the final outcomes were excellent in 11 cases (73.3%),good in 3 (20%), and fair in one(6.7% ).Complications included 3 cases of superficial infection and 2 cases of local skin necrosis, all responding to debridement and dressing.No deep infection, malunion or nonunion occurred.Conclusion Extra-distal tibial nail is a safe and effective alterative solution for open and potentially open fractures of distal metaphyseal tibia.