带锁髓内钉固定并一期植骨治疗股骨干严重粉碎性骨折

目的 探讨提高股骨干严重粉碎性骨折治愈率的方法。方法 对12例严重股骨干骨折行带锁髓内钉固定并一期植骨修复骨缺损。结果 随访1-2年，12例骨折均愈合，愈合时间3-6个月。无肢体短缩，旋转及成角畸形，无感染，主钉无弯曲及断裂，锁钉无断裂及退出。膝关节功能均恢复满意。结论 用带锁髓内钉固定并一期植骨的方法治疗股骨干严重粉碎性骨折，骨折愈合快，并发症少。     

交锁髓内钉治疗陈旧性股骨干骨折

目的：提高交锁髓内钉治疗陈旧性股骨干骨折的效果。方法：对13例陈旧性股骨干骨折采用交锁髓内钉扩髓静力型固定。结果：经6个月-2年4个月随访，骨折全部愈合，关节功能显著改善。结论：交锁髓内钉是治疗陈旧性股骨干骨折的理想方法。对内固定失败选用交锁髓内钉治疗是有效的补救措施。术后可早期功能锻炼。对膝关节功能恢复优于AO钢板固定。     

带锁髓内钉治疗股骨干粉碎性骨折疗效观察

目的探讨带锁髓内钉治疗股骨干粉碎性骨折的疗效.方法使用带锁髓内钉治疗股骨干粉碎性骨折67例，均取前外侧切口，扩髓、静力型固定.结果67例均获随访，时间6～28（16±8）个月.切口均一期愈合.63例术后4—8个月骨折骨性愈合，4例4个月改为动力型固定，11个月愈合，无其他合并症.膝关节功能按Merchant评分标准评定：优43例，良19例，可4例，差1例，优良率92．5％.结论带锁髓内钉治疗股骨干粉碎性骨折可获得满意疗效．     

髓内扩张自锁钉治疗陈旧性股骨干骨折不愈合11例

目的评价髓内扩张自锁钉治疗陈旧性股骨干骨折不愈合的应用价值。方法对11例陈旧性股骨干骨折不愈合行髓内扩张自锁髓内钉内固定并植骨。结果随访6～24个月,11例陈旧性股骨干骨折不愈合患者术后全部愈合,时间为8～21个月。按Kolm ert评定标准：优5例,良5例,可1例。结论髓内扩张自锁髓内钉治疗陈旧性股骨干骨折对骨折端血运影响小,固定较为牢固,便于患肢早期功能活动,是治疗陈旧性股骨干骨折的有效方法。     

带锁髓内钉动力化后股骨干骨折仍不愈合的原因分析及治疗

目的探讨经单皮质锁定钢板固定结合植骨治疗带锁髓内钉动力化后仍不愈合的股骨干骨折的临床效果。方法回顾性分析2009年6月至2012年2月南阳市骨科医院收治的18例股骨干骨折带锁髓内钉动力化后骨折仍不愈合患者的临床资料,均采取单皮质锁定钢板固定加自体骨植骨予以治疗,术后早期进行功能锻炼。结果18例患者获得随访6～24个月,平均随访时间11个月。骨折均获得愈合,愈合时间3～8个月（平均4．5个月）,肢体活动均恢复到术前。结论单皮质锁定钢板固定加植骨治疗带锁髓内钉动力化后股骨干骨折仍不愈合是一种行之有效的方法。     

锁髓内钉治疗股骨干粉碎性骨折疗效观察

目的探讨带锁髓内钉治疗股骨干粉碎性骨折的疗效.方法使用带锁髓内钉治疗股骨干粉碎性骨折67例，均取前外侧切口，扩髓、静力型固定.结果67例均获随访，时间6～28（16±8）个月.切口均一期愈合.63例术后4—8个月骨折骨性愈合，4例4个月改为动力型固定，11个月愈合，无其他合并症.膝关节功能按Merchant评分标准评定：优43例，良19例，可4例，差1例，优良率92．5％.结论带锁髓内钉治疗股骨干粉碎性骨折可获得满意疗效．     

交锁髓内钉治疗股骨干粉碎性骨折

目的探讨使用交锁髓内钉治疗股骨干粉碎性骨折的手术方式选择、疗效。方法对1998年1月～2002年10月使用交锁髓内钉治疗67例(76肢)股骨干粉碎性骨折的疗效进行回顾性分析。手术采用闭合、小切口或有限切开复位，用三维瞄准器锁定骨折远近端。结果平均随访14．1个月，肢体、关节功能恢复优良率92．5％(62／67)，一期骨折愈合率90．8％(69／76)。平均骨临床愈合时问6．7个月。2例软组织感染，感染率2．6％，2例髓内钉断裂。结论交锁髓内钉治疗股骨干粉碎性骨折应常规静力固定，不剥离或少剥离骨膜．不强求解剖复位，尽量闭合复位、有限扩髓，是目前治疗股骨干粉碎性或多节段骨折的有效方法。     

加压钢板与带锁髓内钉治疗肱骨干骨折疗效比较

目的比较加压钢板与带锁髓内钉治疗肱骨干骨折的疗效。方法61例肱骨干骨折患者，骨折复位后38例采用加压钢板、23例采用带锁髓内钉内固定。结果术后平均随访17个月，带锁髓内钉组6个月内骨折愈合率为87．0％（20／23），并发症发生率为0，优于加压钢板组的63．2％（24／38）和23.7（9／38），P〈0．05。结论加压钢板与带锁髓内钉均能可靠固定，但带锁髓内钉能缩短骨折愈合时间，减少并发症，是治疗肱骨干骨折的较好方法。     

联合应用带锁髓内钉及西脉TiNi记忆合金骨卡环治疗股骨干粉碎骨折

目的 观察联合应用带锁髓内钉及西脉TiNi记忆合金骨卡环治疗股骨干粉碎骨折的疗效。方法 本组股骨干粉碎骨折35例，均为AO分型中的B型和C型。其中B型25例，C型10例。全部病例采用开放复位带锁髓内钉加记忆合金骨卡环内固定治疗，5例行植骨。结果 经12～24个月随访(平均18．5个月)，除1例因骨卡环脱落而行手术外，全部病例骨折二期愈合。术后18～24个月取出带锁髓内钉。按Klemm功能恢复分级标准，总体优良率98．2％。结论 带锁髓内钉加记忆合金骨卡环内固定治疗股骨干粉碎骨折可互相取长补短、稳定固定，是一种可行有效的方法：     

固骼生及带锁髓内钉治疗股骨干骨折不愈合(附21例分析)

目的：探讨应用带锁髓内钉加固骼生植骨治疗股骨干骨折不愈合的疗效及优越性。方法：对1999年2月～2001年4月采用带锁髓内钉加固骼生植骨治疗的2l例股骨下骨折不愈合进行总结分析。结果：随访11～30个月。拍片示术后3～6周可见骨痂生长。临床愈合时间最短9周，最长16周，平均13周。未发生骨折不愈合、感染、再骨折、断钉等并发症。结论：应用带锁髓内钉加固骼生植骨治疗股骨干骨折不愈合固定牢固，骨愈合时间短，疗效满意。     

Outcome of intramedullary nail for fixation of osteoporotic femoral shaft fractures in the elderly above 60

IntroductionIntramedullary nailing is an acceptable treatment option for femoral shaft fracture in young patients but not extensively studied in the elderly with osteoporotic fractures. Plate fixation for osteoporotic femoral shaft fractures have a high rate of complications and delayed healing time, and the most acceptable treatment is intramedullary nailing. This study evaluated the healing time and incidence of complications in osteoporotic femoral shaft fractures after intramedullary nailing.Patients &MethodsThis was a retrospective study that included 16 patients above 60 years old with osteoporotic femoral shaft fractures operated between January 2015 and December 2018. Patients with metastatic fractures or with atypical fractures were excluded. Thirteen patients had low-energy injuries such as a simple fall from standing height or lower and twisting injuries. The remaining 3 patients sustained high-energy-mechanism of injury. No patient received bisphosphonate except 2 patients received oral bisphosphonate for a period of 6 and 8 months, respectively.ResultsSixteen patients (12 females and 4 males) with mean age 69.5 ± 3.7 presented with femoral shaft fracture were operated with intramedullary nail, 10 patients were fixed with trochanteric entry nails with proximal neck screws, and 6 patients were fixed with piriformis entry nails. In 9 patients, closed reduction of fracture was achieved while 7 patients required open reduction, of which 5 fracture required cerclage wire addition. The mean bone healing time was 5.35±1.2 months. Intraoperative extension of femoral fractures during intramedullary nail insertion was observed in two cases that required open reduction and addition of cerclage wires around the fracture. The overall incidence of complications was 18.7%.ConclusionsIntramedullary nailing for osteoporotic femoral shaft fracture is a good acceptable option in elderly patients with reasonable healing time with no major complications.     

Intramedullary nailing of femoral shaft fractures. Part II: Fracture-healing with static interlocking fixation

A consecutive, prospective series of ninety-seven patients who had 100 fractures of the femoral shaft that were treated with static interlocking nailing was analyzed to determine the incidence of union of the fracture without planned conversion from static to dynamic intramedullary fixation as a technique to stimulate healing of the fracture. Eighty-four patients (eighty-seven fractures) were studied through union of the fracture (average follow-up, fourteen months). Eighty-five (98 per cent) of the eighty-seven fractures healed with static interlocking fixation. Two patients needed conversion from static to dynamic interlocking fixation because of inadequate fracture-healing; both progressed to uneventful union. The time to full weight-bearing (average, eleven weeks) was individualized for each patient and depended on the cortical contact of the major fragments, the presence of bridging callus as seen on radiographs, and the extent of other injuries of the ipsilateral lower extremity. No deformation or failure of the static interlocking device developed after early walking with weight-bearing, but fatigue failure of one nail occurred in a non-ambulatory patient who had an intracranial injury. Pain related to soft-tissue irritation by the prominent heads of the interlocking screws, clinically presenting as bursitis or snapping of the iliotibial band, was severe enough in six patients to necessitate removal of either the proximal or the distal screw after union of the fracture. We concluded that static interlocking of intramedullary nails in femoral shaft fractures does not appreciably inhibit the process of healing of the fracture, and that routine conversion to dynamic intramedullary fixation, although occasionally necessary, need not be performed.     

阻钉技术对交锁髓内钉断钉的影响

目的探讨阻钉技术对交锁髓内钉断钉的预防作用。方法2003年1月~2005年8月,采用交锁髓内钉固定长骨干骨折56例,男32例,女24例。年龄21~65岁,平均34岁。其中股骨骨折26例,胫骨骨折30例,均为新鲜、闭合性骨折。骨折类型:中部横断骨折10例,中部短斜形骨折11例,中部长斜形或螺旋形骨折20例,远、近1/3骨干骨折15例。前期32例患者采用常规的交锁髓内钉固定骨折(组),后期24例中部长斜形或螺旋形骨折及远、近1/3骨折患者采用交锁髓内钉配合阻钉固定骨折(组)。结果获随访12~21个月,平均16个月。组3例患者骨折未愈合,其中1例股骨中部长斜形骨折主钉在骨折线附近断裂,另2例胫骨远1/3骨折主钉在靠近骨折端的第1个锁钉孔处断裂;其余患者术后6~12个月获骨性愈合,但骨折处出现较多骨痂。组患者于术后3~8个月获骨性愈合,骨折对位、对线良好,无断钉发生。结论阻钉技术配合交锁髓内钉应用可明显增强骨折断端稳定性,减少断钉发生。     

Femoral shaft fracture callus formation after intramedullary nailing: a comparison of interlocking and Ender nailing

 Intramedullary nailing is widely used for the operative treatment of femoral fractures. Recently, the biologic healing of fractures has become better understood from fundamental investigations. However, there has been no clinical comparison between the fracture healing process with these two fixation methods. The purpose of this study was to use radiographs to compare callus formation with two types of intramedullary nailing for femoral shaft fractures: reamed interlocking (IL) nails and Ender nails. Femoral shaft type A fractures (AO classification) were studied. Twenty-seven fractures were treated with reamed IL nailing, and 81 fractures were treated with Ender nailing. The callus area was calculated from the maximum cross-sectional area on the anteroposterior and lateral radiographs. The callus appeared at a mean of 3.9 weeks after surgery in the IL group, and at a mean of 2.8 weeks in the Ender group (P < 0.05). In the IL and Ender groups, fracture healing was noted at a mean of 3.4 and 2.0 months, respectively. The mean area of callus formation in the IL and Ender nailing groups was 439.5 mm² and 699.4 mm², respectively (P < 0.02). Ender nailing results in abundant callus, which forms at an earlier stage after the procedure than in patients treated with IL nailing. Dynamization at the fracture site is reported to increase external callus formation. Our results indicate that the elasticity of the fixation obtained with Ender nailing promotes callus formation. Received: November 9, 2001 / Accepted: February 13, 2002     

交锁髓内钉治疗股骨干骨折术后感染和骨吸收的处理

目的 探讨交锁髓内钉治疗股骨干骨折术后感染及骨吸收的治疗方法。方法股骨十骨折交锁髓内钉固定术后感染及骨吸收13例,术后感染平均14．5个月。第一期拔除髓内钉、彻底清创、外同定支架固定,第二期植骨、抗感染;术后膝关节功能锻炼。结果随访平均4．2年。1年后骨折和感染均治愈,随访期内均无复发。结论合理的二期手术,是治疗交锁髓内钉固定股骨干骨折术后感染及骨吸收的可行方法。     

闭合复位带锁髓内钉治疗股骨干骨折

目的：探讨闭合复位带锁髓内钉治疗股骨干骨折的临床疗效.方法：自2006年3月至2011年12月采用闭合复位带锁髓内钉治疗103例股骨干骨折患者,其中男76例,女27例;年龄19～55岁,平均36岁.按照AO分型：A型64例,B型27例,C型12例;开放性骨折13例（Gustilo Ⅰ型5例,Ⅱ型8例）.观察术后患者骨折愈合时间,并采用膝关节HSS评分标准对术后1年膝关节功能恢复情况进行评价.结果：术中发生股骨颈骨折1例,股骨近端骨折1例,均于术中更换重建钉固定,术后骨折愈合.术中发生腓总神经损伤1例,营养神经治疗4个月后恢复.103例患者全部获得随访,时间12～28个月,平均22个月.全部患者获得骨性愈合,愈合时间3～9个月,平均5个月.髋关节功能全部恢复正常,术后1年膝关节行HSS评分平均90.89±5.06.结论：注重手术操作,力求闭合复位,减少并发症,带锁髓内钉是治疗股骨干骨折的首选方法.     

闭合复位交锁髓内钉固定治疗股骨干骨折

目的探讨闭合复位交锁髓内钉治疗股骨干骨折的疗效。方法对32例股骨干骨折应用闭合复位交锁髓内钉治疗，均闭合复位顺行置钉。结果所有患者随访6～26个月，术后复位满意，骨折平均愈合时间12周，术后均愈合良好，无主钉或锁钉断裂，无肢体短缩、功能障碍、感染。结论闭合复位交锁髓内钉是治疗股骨干骨折的一种创伤小、并发症少、骨愈合时间短、术后患者恢复好的内固定方法。     

重建型交锁髓内钉治疗复杂股骨骨折

目的　探讨重建型交锁髓内钉治疗复杂股骨骨折的临床疗效,掌握手术方法及注意事项。方法　对 18例复杂股骨骨折采用重建型交锁髓内钉固定,闭合或开放穿钉。结果　18例经 6~19个月的随访,愈合时间4 5~10个月,平均 6 5个月,优良率达 94%,无相关并发症。结论　颈干交锁,将整个固定系统与股骨头颈干构成一相对完整牢固的整体,可早期负重,功能锻炼,有利骨折愈合,重建型交锁髓内钉是治疗复杂股骨骨折的理想方法。     

Acute unreamed intramedullary nailing and soft tissue reconstruction with muscle flaps for the treatment of severe open tibial shaft fractures

BACKGROUND: The treatment of open tibial shaft fractures remains controversial. Important considerations in surgical management include surgical timing, fixation technique and soft tissue coverage. This study was performed to evaluate the results of acute surgical debridement, unreamed nailing and soft tissue reconstruction in the treatment of severe open tibial shaft fractures. PATIENTS AND METHODS: During a 10-year period between January 1993 and July 2002, 927 tibial shaft fractures were treated with interlocking intramedullary nails. Among them, there were 19 consecutive patients with Gustilo type IIIB to IIIC open tibial shaft fractures with extensive soft tissue injury needing a muscle flap coverage and being suitable for intramedullary nailing. All 19 patients were called for a late follow-up which was conducted with a physical examination and a radiographic and functional outcome assessment. The radiographs were reviewed to determine the fracture healing time and the final alignment. RESULTS: All 19 open fractures with severe soft tissue injury healed without any infection complications. The fractures united in a mean of 8 months. Nine patients had delayed fracture healing (union time over 24 weeks). One of these patients needed exchange nailing, one patient autogenous bone grafting and dynamisation on the nail and seven patients needed dynamisation of the nail before the final fracture healing. In all patients, the alignment was well maintained. However, seven patients had shortening of the tibia by 1-2 cm and two of them also external rotation of 10 degrees . The functional outcome was good in 18/19 patients. INTERPRETATION: Acute surgical debridement, unreamed interlocking intramedullary nailing and soft tissue reconstruction with a muscle flap appear to be a safe and effective method of treatment for Gustilo type IIIB open tibial shaft fractures.     

可膨胀髓内钉治疗四肢长骨骨折

[目的]探讨可膨胀髓内钉Fixion^TM系统治疗长管状骨骨折的临床应用效果。[方法]自2004年9月．2006年1月，共30例患者采用Fixion^TM可膨胀髓内钉系统（Disco-O-tech Herzliya，lsreal）进行治疗；所有患者均为外伤引起的四肢长管状骨骨折，其中男17例，女12例，年龄22—82岁；开放性骨折1例，骨不连患者1例；股骨转子间骨折7例，股骨干骨折9例，肱骨骨折7例，胫骨骨折7例。可膨胀自锁髓内钉（IM）18例，可膨胀交锁髓内钉（IL）5例，股骨近端髓内钉（PF）7例。一般术后10d允许患者部分负重，若负重时患者骨折处出现明显疼痛应推迟。[结果]本组30例伤口全部I期愈合，手术时间30～140min，平均65min，术中出血50～1200ml，平均300ml。30例患者全部获得随防，随访时间12～72周，平均40周。术后根据临床和影像学平均愈合时间为：股骨转子间骨折11周，股骨干骨折12．2周，胫骨干骨折13周，肱骨骨折11周。其中1例为肱骨干骨折术后骨不连，再次手术后3个月，骨折处骨痂形成。[结论]可膨胀髓内钉应力分布均匀，避免了应力遮挡效应；一般无需扩髓和锁钉．减少了创伤和手术时间，医生和患者接受的X线剂量少和感染率低；轴相弹性动力化固定，加快了骨折愈合时间，避免了交锁髓内钉2次动力化手术给病人带来肉体和精神上的痛苦等。临床初步应用疗效满意，为长管状骨骨折的治疗提供一种新型的理念和固定技术，在掌握好适应证、正确操作的前提下，采用Fixion^TM可膨胀髓内钉系统治疗长管状骨骨折有可能获得较传统交锁髓内钉更好的效果。