Rates and odds ratios for complications in closed and open tibial fractures treated with unreamed, small diameter tibial nails:: A multicenter analysis of 467 cases
Rates and odds ratios for complications in closed and open tibial fractures treated with unreamed, small diameter tibial nails:: A multicenter analysis of 467 cases
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DOI：
10.1097/00005131-200108000-00006
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发表时间：
2001-08-01
影响因子：
2.3
通讯作者：
Vécsei, V
中科院分区：
文献类型：
--
作者：
Gaebler, C;Berger, U;Vécsei, V
目的：一项多中心研究，分析小直径髓内钉固定的开放性和闭合性胫骨骨折的并发症及发生并发症的几率。设计：回顾。背景：4个I级创伤中心。患者：467例胫骨骨折。其中近端骨折52例，中段骨折219例，远端骨折196例。A型骨折135例，B型骨折216例，C型骨折116例。结果：对265例闭合性骨折和2 0 2例开放性骨折进行了临床和X线分析。方法：采用非扩髓小直径胫骨髓内钉固定胫骨骨折。使用非扩髓技术的小直径胫骨髓内钉的适应证包括所有类型的开放性或闭合性骨干骨折。手术医生根据个人经验、骨折类型和软组织损伤情况决定是否扩髓。中心I的外科医生倾向于用非扩髓钉治疗A型和B型骨折，中心2、3和4的外科医生倾向于用非扩髓的钉治疗B型和C型骨折。结果：分析显示5例(1.1%)深部感染(Gustito III级开放性骨折深部感染率5.4%)，43例延迟愈合(9.2%)，12例(2.6%)骨不连。发生骨筋膜室综合征62例(13.3%)，螺钉疲劳47例(10%)，胫骨髓内钉疲劳失效3例(0.6%)。结论：用不扩髓的小直径钉固定胫骨骨折时，骨折牵张超过3毫米是不能容忍的，因为这会使延迟愈合的几率增加12倍(p<；0.001)，骨不连的几率增加4倍(p=0.057)。在三级开放性骨折组(p<；0.001)、AO/OTAC型骨折组(p=0.002)，并发症的发生率显著增加，远端骨折的并发症发生率较低。然而，导致重大并发症的严重并发症的发生率很低。
Objective: A multicenter trial analyzed complications and odds for complications in open and closed tibial fractures stabilized by small diameter nails.Design: Retrospective.Setting: Four Level I trauma centers.Patients: Four hundred sixty-seven tibial fractures were included in the study. There were fifty-two proximal fractures, 219 midshaft fractures, and 196 distal fractures. Breakdown into different AO/OTA groups showed 135 Type A fractures, 216 Type B fractures, and 116 Type C fractures. Two hundred sixty-five were closed fractures and 202 were open fractures.Outcome Measurements: Clinical and radiographic analysis.Methods: 467 patients' tibial fractures were stabilized with small diameter tibial nails using an unreamed technique. Indications for the use of small diameter tibial nails using an unreamed technique included all types of open or closed diaphyseal fractures. The operating surgeons decided whether or not to ream based on personal experience, fracture type, and soft-tissue damage. Surgeons of Center I preferred to treat AO Type A and B fractures with unreamed nails, and surgeons of Centers 2, 3, and 4 preferred to treat AO Type B and C fractures with unreamed nails. Closed and open fractures were treated in approximately the same ratio.Results: Analysis showed five (1.1 percent) deep infections (with a 5.4 percent rate of deep infections in Gustito Grade III open fractures), forty-three delayed unions (9.2 percent), and twelve (2.6 percent) nonunions. Compartment syndromes occurred in sixty-two cases (13.3 percent), screw fatigue in forty-seven cases (10 percent), and fatigue failure of the tibial nail in three cases (0.6 percent).Conclusions: Fracture distraction of more than three millimeters should not be tolerated when stabilizing tibial fractures with unreamed, small-diameter nails as this increases the odds of having a delayed union by twelve times (p < 0.001) and a nonunion by four times (p = 0.057). There was a significant increase of complications in the group of Grade III open fractures (p < 0.001), AO/OTA Type C fractures (p = 0.002), and to a lesser extent in distal fractures. However, the rate of severe complications resulting in major morbidity was low.