CAJ | 학술논문

目的：探讨微创弹性髓内钉结合外固定支架治疗粉碎性闭合胫腓骨干骨折的疗效。方法：2010年6月至2012年6月采用微创弹性髓内钉结合外固定支架技术治疗58例粉碎性闭合胫腓骨骨干折患者，男31例，女27例；6例。根据Winquist-Hanson粉碎分级，1级23例，2级17例，3级12例，4级6例。终末随访根据Johner-Wruhs评分比较各治疗组患者疗效。结果：58例均获随访，时间18～36周，平均6.8个月。58例均获得骨性愈合，临床愈合时间为24～32周，平均28周。1级粉碎组优良率在明显高于其他3组，并发症的发生率随粉碎级别增高而增高，愈合时间随着粉碎级别增高而延长。C3型骨折并发症发生率明显高于其他组，优良率明显低于其他组，B1型骨折并发症发生率明显低于其他组，优良率明显高于其他组。结论：微创弹性髓内钉结合外固定支架技术治疗多段、长螺旋轻中度粉碎伴隐匿骨裂闭合性胫腓骨骨折能够获得满意的复位和可靠的固定，完全符合BO原则，最大程度保护了骨折端血运，减少带架时间，皮肤软组织并发症少，术后功能恢复满意。
목적：탐토미창탄성수내정결합외고정지가치료분쇄성폐합경비골간골절적료효。방법：2010년6월지2012년6월채용미창탄성수내정결합외고정지가기술치료58례분쇄성폐합경비골골간절환자，남31례，녀27례；6례。근거Winquist-Hanson분쇄분급，1급23례，2급17례，3급12례，4급6례。종말수방근거Johner-Wruhs평분비교각치료조환자료효。결과：58례균획수방，시간18～36주，평균6.8개월。58례균획득골성유합，림상유합시간위24～32주，평균28주。1급분쇄조우량솔재명현고우기타3조，병발증적발생솔수분쇄급별증고이증고，유합시간수착분쇄급별증고이연장。C3형골절병발증발생솔명현고우기타조，우량솔명현저우기타조，B1형골절병발증발생솔명현저우기타조，우량솔명현고우기타조。결론：미창탄성수내정결합외고정지가기술치료다단、장라선경중도분쇄반은닉골렬폐합성경비골골절능구획득만의적복위화가고적고정，완전부합BO원칙，최대정도보호료골절단혈운，감소대가시간，피부연조직병발증소，술후공능회복만의。
Objective:To investigate the clinical results of external fixation and AO titanium elastic intramedullary nail?ing for treatment of tibia fibula comminuted closed fractures. Methods:From June 2010 to June 2012,58 patients with tibia-fibula comminuted closed fractures were treated with external fixation and AO titanium elastic intramedullary nailing ,includ?ing 31 males and 27 females with an average age of 38.5 years old ranging from 21 to 57 years old. According to the system of AO Classification,the fractures were classified as type B1 in 9 cases,type B2 in 7 cases,type B3 in 10 cases,type C1 in 14 cases,type C2 in 12 cases,and type C3 in 6 cases. According to the system of Winquist-Hanson,the fractures' comminuted were classified as grade 1 in 23 cases,grade 2 in 17 cases,grade 3 in 12 cases,and grade 4 in 6 cases. According to the sys?tem of Johner-Wruhs,clinical results were compared between different type and grade groups by the time of last followed up. Results:All 58 patients were followed up with an average time of 6.8 months(ranged from 18 to 36 weeks). All fractures had clinical healing with an average time of 28 weeks(ranged from 24 to 32 weeks). The total rate of good to excellent results was 91.4%. The rate of good to excellent in the group of grade 1 was higher than that of other grades. The complication rates and fracture healing time would increase respectively with higher Winquist-Hanson's grade. The complication rates in the group of type C3 was higher than that of other types,but the rate of good to excellent was lower than that of other types. The complica?tion rates in the group of type B1 was lower than that of other types,but the rate of good to excellent was higher than that of oth?er types. Conclusion:Minimal invasiveusing AO titanium elastic intramedullary nailing combined with external fixation for treatment of tibia fibula fractures especially for the multiple segment,long spiral mild to moderate comminuted with hidden fracture can get satisfactory reduction and reliable fixation,it conformes to the principle of BO completely,protects the frac?ture end blood supply,reduces the external fixation time,has less skin soft tissue complications,postoperative function recov?ered satisfactorily.