A Comparison between Interlocking Intramedullary Nailing with and without Reaming for the Treatment of Closed Unstable Tibial Shaft Fractures: A Prospective, Randomized Study

骨髓腔擴鑽與否在互鎖式髓內釘治療閉鎖性不穩定腔骨幹骨折之比較

林希鼎(Hsi-Ting Lin) ； 陳清安(Cheng-Aun Tan) ； 鄭正文(Cheng-Wen Cheng) ； 梁福民(Louis F. Leung) ； 王拔群(Pa-Chun Wang) ； 沈博文(Po-Wen Shen) ； 陳雅惠(Ya-Hui Chen) ； Cheng-Aun Tan

《輔仁醫學期刊》 4卷4期 (2006/12) Pp. 167-176

摘要

Background and Purpose: Although reamed interlocking nailing has been reported to show good clinical results, the introduction of stronger interlocking nails that can be inserted without reaming has raised questions as to whether intramedullary reaming is necessary. The objectives of this study were to determine if any differences in outcomes exist between reamed and unreamed closed interlocking nailing in patients with unstable closed tibial shaft fractures. Methods: The study was conducted in a prospective, randomized, and comparative manner. Between July 1, 2002, and December 31, 2004, fifty three consecutive patients with unstable closed tibial shaft fractures treated with intramedullary nail insertion with or without medullary canal reaming were included in the study. Time to fracture healing, the type and incidence of complications, and the number of secondary procedures performed to obtain union were the main outcome measurements. Results: The overall average fracture healing time was 21 (range, 11-50) weeks. In the reamed group, the fractures healed in an average of 19 weeks, while in the unreamed group, it took an average of 23 weeks. Differences in operative time, perioperative blood loss, the complication rate, the number of secondary procedures, and implant failure between the reamed and unreamed groups were not statistically significant. Complications developed more frequently with proximal and distal fractures (p=0.003). Comminution of the fracture itself was an important factor in fracture healing (p=0.037), and insertion of a larger diameter nail may have promoted bone consolidation by virtue of the increased stability achieved by the increased contact area between the implant and the bone surface (s=-2.48, p＜0.001). Conclusions: For simple or wedged mid third tibia shaft fractures, interlocking intramedullary nailing, regardless of whether reaming is carried out, may produce satisfactory results. But for treating highly comminuted proximal or distal tibial shaft fractures, intramedullary reaming of the canal to accommodate larger diameter nails may facifitate fracture union.

關鍵字

經骨幹骨折 ； 骨髓腔擴鑽 ； 髓內釘 ； 骨折癒合

並列摘要

Background and Purpose: Although reamed interlocking nailing has been reported to show good clinical results, the introduction of stronger interlocking nails that can be inserted without reaming has raised questions as to whether intramedullary reaming is necessary. The objectives of this study were to determine if any differences in outcomes exist between reamed and unreamed closed interlocking nailing in patients with unstable closed tibial shaft fractures. Methods: The study was conducted in a prospective, randomized, and comparative manner. Between July 1, 2002, and December 31, 2004, fifty three consecutive patients with unstable closed tibial shaft fractures treated with intramedullary nail insertion with or without medullary canal reaming were included in the study. Time to fracture healing, the type and incidence of complications, and the number of secondary procedures performed to obtain union were the main outcome measurements. Results: The overall average fracture healing time was 21 (range, 11-50) weeks. In the reamed group, the fractures healed in an average of 19 weeks, while in the unreamed group, it took an average of 23 weeks. Differences in operative time, perioperative blood loss, the complication rate, the number of secondary procedures, and implant failure between the reamed and unreamed groups were not statistically significant. Complications developed more frequently with proximal and distal fractures (p=0.003). Comminution of the fracture itself was an important factor in fracture healing (p=0.037), and insertion of a larger diameter nail may have promoted bone consolidation by virtue of the increased stability achieved by the increased contact area between the implant and the bone surface (s=-2.48, p＜0.001). Conclusions: For simple or wedged mid third tibia shaft fractures, interlocking intramedullary nailing, regardless of whether reaming is carried out, may produce satisfactory results. But for treating highly comminuted proximal or distal tibial shaft fractures, intramedullary reaming of the canal to accommodate larger diameter nails may facifitate fracture union.

並列關鍵字

tibial fractures ； intramedullary reaming ； intramedullary nailing ； fracture healing