Closed or Open Fracture of the Tibia A Report of 125 Patients Treated with Intramedullary Nail

脛骨骨折以骨髓內釘固定治療－125病例分析報告

方修強(Siew-Kiong Huon) ； 陳學明(Hsueh-Ming Chen) ； 陳銀才(In-Chai Chen) ； 林以禮 ； 童瑞年(Jai-Nieu Tung) ； 童瑞欽

《Journal of Orthopaedic Surgery Taiwan》 6卷1期 (1989/03) Pp. 1-9

摘要

脛骨骨折(fracture of tibia)是一種常見的骨折，其治療的方法也很多，本院自民國六十九年一月至七十五年十月共有一二五病例以骨髓內釘(intramedullary nail)來治療，對於骨髓內釘的選擇，通常單純性的骨折我們用Ender nail、Lottes nail及kuntscher nail，如是粉碎性的骨折則用interlocking nail，其可預防下肢的旋轉力量(rotainoal forces)及變短(shortening)。對於手術後還不夠穩定的患者我們則加以石膏固定。以骨髓內釘治療是一種快速、簡單、易學的方法，不但病人可在緊急時手術而減輕疼痛且可早日出院，恢復運動功能快及感染率亦低。因此，脛骨骨折以骨髓內釘固定治療是一種很好的方法，但第三度的開放性骨折和脛骨粗隆(tibial tuberosity)6公分以內及脛骨末端(tibio-tarsal joint)5公分內的骨折則例外。
脛骨骨折以骨髓內釘或鋼板(plate)來治療其骨折癒合的時間及血液的供應情況，由各文獻回顧得知，骨髓內釘的癒合是以外骨痂(external callus)性皮質癒合較多，而鋼板的癒合是以內骨痂(internal callus)性皮質癒合較多，一但骨痂癒合形成之後，其骨折癒合不論用骨髓內釘或鋼板治療時先由骨膜的循環(periosteal circulation)來供應，等皮質新的血管形成再由新的血管供應，因此，用骨髓內釘或鋼板對骨折癒合所需的血液供應是不成問題。

並列摘要

There were one hundred and twenty-five patients of tibia fracture which were treated by closed reduction and internal fixation with intramedullary nail. We used Ender pins in two cases, Lottes nail in twenty cases, Kuntscher nail in ninety-three cases and interlocking nail in ten cases. The average time of clinical union was 13.05 weeks. The average length to follow up was 30 months. Patients were able to ambulate with crutches after two or three days postoperation. The major complications were infection in three cases (2.4%), nonunion in two cases (1.6%), malunion in four cases (3.4%), broken nail in one case (0.8%) and jamming of the nail on the canal during operation in two cases(1.6%).

並列關鍵字

fracture of tibia ； intramedullary nail