CAJ | 학술논문

目的总结超远端髓内钉结合阻挡螺钉治疗胫骨远端骨折的手术方法,评估该方法的临床疗效. 方法 2008年4月-2012年9月应用超远端髓内钉结合阻挡螺钉治疗21例胫骨远端骨折患者,均采用闭合复位、不扩髓技术、静力固定.对相对简单骨折在常规插入髓内钉后骨折复位和稳定性不满意,即拔除髓内钉置入阻挡螺钉;对严重粉碎骨折,直接在透视下置入阻挡螺钉.术后3周允许患肢部分负重行走,随访评估骨折复位、骨愈合和功能恢复情况. 结果平均随访17.5个月(12～22个月),无皮肤坏死、软组织和骨性感染发生.所有骨折均愈合,平均愈合时间12.5周(8～ 26周),X线片测量骨折部位在冠状面、矢状面平均成角＜5°,无阻挡螺钉及髓内钉变形、断裂等情况.参照Tormetta功能评分标准:优19例,良2例. 结论治疗胫骨远端骨折时,阻挡螺钉通过缩小髓腔直径辅助骨折复位、提高固定稳定性,扩大了髓内钉的应用范围.
목적 총결초원단수내정결합조당라정치료경골원단골절적수술방법,평고해방법적림상료효. 방법 2008년4월-2012년9월응용초원단수내정결합조당라정치료21례경골원단골절환자,균채용폐합복위、불확수기술、정력고정.대상대간단골절재상규삽입수내정후골절복위화은정성불만의,즉발제수내정치입조당라정;대엄중분쇄골절,직접재투시하치입조당라정.술후3주윤허환지부분부중행주,수방평고골절복위、골유합화공능회복정황. 결과 평균수방17.5개월(12～22개월),무피부배사、연조직화골성감염발생.소유골절균유합,평균유합시간12.5주(8～ 26주),X선편측량골절부위재관상면、시상면평균성각＜5°,무조당라정급수내정변형、단렬등정황.삼조Tormetta공능평분표준:우19례,량2례. 결론 치료경골원단골절시,조당라정통과축소수강직경보조골절복위、제고고정은정성,확대료수내정적응용범위.
Objective To determine the surgical procedures and effects of ultra-distal tibial intramedullary nails combined with blocking screws in treatment of distal tibial fractures.Methods From April 2008 to September 2012,21 cases of distal tibial fractures were treated with ultra-distal tibial intramedullary nails combined blocking screws.All fractures were statically locked and closed using undreamed technique.For relatively simple fracture,blocking screws were considered when the reduction and stability was not satisfied after the insertion of intramedullary nails; for severe comminuted fractures,blocking screws were inserted directly under C-arm fluoroscopy.Partial weight-bearing was permitted 3 weeks after surgery.Quality of reduction,fracture union,and function assessment were measured at follow-up.Results No skin necrosis and soft tissue and bone infections occurred after a mean follow-up of 17.5 months (range,12-22 months).All fractures were healed with an average healing time of 12 months (range,8-26 months).X-ray findings revealed the fracture of ＜ 5° angulation on coronal and sagittal planes.There was no deformation or breakage of blocking screws and intramedullary nails.According to the criteria of Tormetta,the results were excellent in 19 cases and good in 2.Conclusion Blocking screws assists reduction and improve the fixation stability by narrowing the canal in treatment of distal tibial fractures and expands the application of intramedullary nails.