頁籤選單縮合
題 名 | 困難的脛骨骨折使用經由踝關節做骨髓內固定及補骨的治療經驗 |
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作 者 | 沈永訓; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 12:1 1979.03[民68.03] |
頁 次 | 頁34-41 |
關鍵詞 | 骨髓內固定; 補骨; 踝關節; 脛骨骨折; |
語 文 | 中文(Chinese) |
英文摘要 | Infected non-union of a lower leg fracture is one of the most difficult situations an orthopedic surgeon encounters. Not only is there infection but also a grave skin condition. Especially when the lesion is near the ankle, there is no sure way to treat it. In order to overcome this difficult condition this author tried vertical transarticular Kuntscher's nail fixation. Bacterological study of the wound before operation was done. During operation the wound was thoroughly debrided, sequstrae removed, and the marrow cavity cleaned. Then a proper size K-nail, approximately 10 mm (9-11 mm) in diameter and 30 cm in length, was chosen for nailing. With or without T-V X-ray control, a guide pin was introduced from a transverse incision in the sole. Kuntscher's nailing followed the guide pin. The distal tip of the K-nail was kept deep in the subcutaneous tissue to prevent a painful sole. Adequate iliac bone graft was tightly irnpacted around the fracture site. Skin was, if possible, snugly approximated. If the wound was too big to be sutured, then vaseline gauze dressing was applied on the wound with sufficient compression. The first dressing change was done a week postoperatively. No external immobilization was used. This procedure provided very strong fixation so that the patient was usually ambulatory in the fust week. In 11 cases that had this operation there was one failure due to inadequate stabilization. The rest of the 10 cases had solid union in 3-6 months. All wounds healed except in two cases, where there superficial skin defects. Eight cases had the nail removed six months after the operation, and were followed for 8-24 months. All patients resumed previous work. All patients accepted the stiff ankle joints which had existed even before this procedure. Case 8 (Fig. 3) was an exception, because the procedure was carried out immediately after the accident due to circumferential avulsion of the skin and severe ankle injury. He regained 70% of the ankle motion seven months after removal of the nail. So far no patient has complained of pain or swelling, but since the X-Ray films revealed narrowing of the joint space, future development of arthritis has to be carefully observed for. |
本系統中英文摘要資訊取自各篇刊載內容。