摘要
目的评价带锁髓内钉治疗股骨、胫骨和肱骨骨折的疗效。方法回顾性分析自1994年4月至2003年9月应用带锁髓内钉治疗长骨骨折546处(526例)。男430处(412例),女116处(114例);平均年龄36.4岁。新鲜闭合骨折432处,开放骨折38处;陈旧骨折76处。手术利用“C”型臂或“G”型臂行闭合复位或切开复位内固定。其中闭合复位194处,切开复位352处;扩髓485处,未扩髓61处;静力型固定539处,动力型固定7处;顺行髓内钉固定519处,逆行髓内钉固定27处。结果平均随访时间31.6个月(9～123个月),543处骨折获得愈合,愈合率为99.5%,骨折平均愈合时间为4.4个月。其中531处(97.2%)一期愈合,12处(2.2%)二期愈合。延迟愈合11处(2.0%),10处经动力化,1处维持外固定和制动,均获得骨性愈合;骨折不愈合4处(0.7%),1处经更换带锁髓内钉后骨折愈合;畸形愈合3处(0.5%);感染5处(0.9%);外伤性骨折2处(0.4%);内固定失败7处(1.3%),其中主钉断裂3处,远侧锁钉弯曲或退出4处。髋周异位骨化9处;桡神经轻瘫1例;肺栓塞1例。股骨或胫骨骨折患者,术后肩、膝、髋关节功能活动优良,术后膝前痛15例,肩部疼痛6例。结论带锁髓内钉是治疗股骨、胫骨和肱骨骨折的一种较好的方法。新鲜长骨骨折尽可能闭合复位、陈旧骨折切开复位,均采用静力固定,根据骨折部位和伤情选?
Objective To evaluate the clinical results of femoral, tibial and humeral fractures treated with locked intramedullary nailing. Methods 546 fractures of femur, tibia, and humerus in 526 patients treated with locked intramedullary nailing from April 1994 to September 2004 were retrospectively reviewed. There were 430 fractures in 412 males, 116 fractures in 114 females, with an average age of 36.4 years. 432 were close fractures, 76 old fractures, and 38 open fractures. With image intensifier, 196 fractures were reduced closely, while 350 fractures failed to be reduced by close manipulation and required open reduction. Bone grafting were undertaken in 161 fractures of the latter group. 485 fractures were reamed, and 61 unreamed. 539 fractures were stabilized statically, and 7 dynamically. The nails were inserted antegradely in 519 fractures, and retrogradely in 27. Dynamization was undertaken in 10 statically locked fractures due to delayed union. The early postoperative weight-bearing was directed. The patients were followed up with an average of 31.6 months (9~123 months). Results Among the 546 fractures, 543 fractures(99.5%) were eventurally healed, with an average union time of 4.4 months. 530 fractures(97.1%)primarily healed, and 13 fractures(2.4%) healed after secondary operation. The complications were 11 delayed unions(2.0%), 4 nonunions(0.7%), 3 malunions(0.5%), 5 bone infections(0.9%), 2 traumatic fractures(0.4%), 9 hip heterotopic ossifications(1.6%), 6 implant failures(1.0%), with 3 nail breakages(0.5%), 3 interlocking screw breakages or back-outs, 1 radial nerve palsy, and 1 fatal pulmonary embolism. The ROM of the hips and the knees were excellent in patients with femoral or tibial fractures. Flexion restriction(90°~125°) of the knee were found in 10 patients. There were 5 and 10 anterior knee pains in femoral and tibial fracture patients respectively. The ratio of excellent and good function of the shoulder was high in the humeral shaft fracture patients, with the abduction less than 90° in 2 patients, extension loss of 15° in 2 elbows, and shoulder pain in 6 patients. Conclusion Interlocking intramedullary nailing is one of the good alternatives in treating long bone fractures, with a higher union rate and a lower complication rate. Close reduction for fresh fracture, open reduction for old fracture, static locking, reaming or unreaming in regard to the site and severity of the fracture, and individualized rehabilitation protocols all contribute to the excellence of the results.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2005年第3期136-142,共7页
Chinese Journal of Orthopaedics
