形成外科医に知ってもらいたい骨折の骨再建

Knowledge of Osteosynthesis for the Reconstruction of Severe Extremity Trauma

はじめに

　重度四肢外傷の治療において，その両輪ともいえるのが軟部組織再建と骨再建である。治療を成功させるにはこれらの両立が不可欠であり，特にコラボレーション治療を行う際にはお互いに両方を理解しておくことが重要である 1）。

　近年，locking plate systemや髄内釘の横止め機構の進歩により，これらをうまく使いこなすことで，今まで困難に思われた骨折内固定をより強硬でかつ低侵襲に行うことが可能となった。本稿では，外傷整形外科医としての著者の経験なども踏まえて，重度四肢外傷治療における初期固定と内固定の考え方について述べる。

　In the treatment of severe extremity trauma, it is necessary to perform both soft tissue reconstruction and bone reconstruction. Failure to successfully treat fractures hinders the treatment of severe extremity trauma. In the treatment of bone fractures, a major goal is to not only reduce the fractured part and perform internal fixation to obtain bone union but also to obtain sufficient initial fixation force to enable the patientʼs early physical therapy. In order to reach this goal, it is necessary to have a thorough understanding of both the basic theory of osteosynthesis and recent advances in internal fixation materials and fixation methods. In particular, advances in the function of intramedullary nails have expanded these nailsʼ application to the metaphyseal region, and there are cases in which a skin flap is not required if intramedullary nails is performed appropriately. However, there may be a limited number of surgeons who can perform such a difficult internal fixation. The timing of the internal fixation and the skin flap construction should also be carefully considered and performed appropriately. Knowledge of osteosynthesis is very important for the reconstruction of severe extremity trauma.