带锁髓内钉治疗新鲜四肢长骨干骨折1224例疗效分析

目的总结带锁髓内钉治疗肱骨干、股骨干、股骨髁上、胫骨干和转子间骨折的疗效。方法自1996年10月至2004年6月间使用带锁髓内钉治疗的有完整资料的新鲜四肢骨折1224例,男778例,女446例;平均年龄39岁(16￣92岁)。骨折位于肱骨干92例,股骨转子间210例,股骨干488例,股骨髁上92例,胫骨342例。闭合骨折按AO分型:A型642例;B型364例;C型218例。开放骨折15例(GustiloⅠ型8例,GustiloⅡ型7例)。受伤至手术时间平均为8d(3h￣33d)。闭合复位1203例,切开复位23例;扩髓409例,非扩髓815例。结果平均随访时间为24个月(6￣70个月)。1204例骨折愈合,愈合率为98.2%,平均愈合时间为5个月(3￣12个月)。骨折不愈合22例,其中肱骨4例,股骨8例,股骨髁上4例,胫骨6例,总不愈合率为1.8%。术后无急性感染发生,3例发生晚期深部感染,总感染率为0.2%。术中16例发生严重骨折劈裂,4例为肱骨逆行髓内钉固定,4例Gamma钉固定,9例为股骨逆行髓内钉固定,占1.3%。6例发生医原性神经损伤,占0.4%。股骨髓内钉主钉断裂1例,锁钉断裂9例(0.6%)。晚期髓内钉末端骨折3例,占0.2%。53例主诉髓内钉尾端部位不适,占4.3%。结论闭合复位带锁髓内钉治疗骨干骨折在骨折愈合率、感染率、出血量、功能恢复情况和早期活动方面均较满意,是治疗骨干骨折较好的方法,但

The treatment of extremity fractures using the interlocking nail

Objective To evaluate the effect of the interlocking nail for extremity fractures. Methods This study reviews 1224 cases of extremity fractures treated with locking intramedullary nail fixation from October 1996 to June 2004, including 92 cases humeral shaft fracture; 210 cases intertrochanteric fractures; 488 cases femoral shaft fractures; 92 cases supracondylar femoral fractures; 342 cases tibia and fibular fractures. According to the AO classification there were 642 type A, 364 type B and 218 type C. There were 986 cases (72.4%) high-energy injury; 405 cases were multiple injury. There is 778 male and 446 female with mean age 39 years (range 16-92 years). Duration from injury to operation was 8 days(3 hour-30 days). Close reduction was 1203 cases and open reduction were 21 cases. Results Mean follow-up period is 24 months(6-70 month), mean operation time was 90 minutes(40-480 minutes). Union was in 1204 cases, union rate was 98.2%, mean union time was 5 months (3-12 months) on average, there were nonunion in 22 patients: 4 in humeral shaft, 8 in femoral shaft, 4 in supracondylar femur, 6 in tibia shaft, the nonunion rate is 1.8%. Late deep infection occurred in 3 patients: 1 in femoral shaft, 1 in supracondylar femur, 1 in intertrochanteric femur, the infection rate is 0.2%. There were 16 split in intraoperation: 4 in humeral nail, 4 in Gamma nail, 9 in supracondylar nail. Iatrogenic nerve palsy occurred in 6 patients: 2 in radial nerve, 2 in sciatic nerve, 2 in common peroneal nerve, the occurrence is 0.4%. One femoral nail was broken, locking screw were broken in 9 patients (0.6%), femoral shaft fracture of distal nail end occurred in 3 cases: 1 in Gamma nail, two in supracondylar nail. 53 patient complained uncomfortable in entry point (8 shoulders; 9 hips; 36 knees). Conclusion The result is satisfactory in bone healing low infection reduced blood loss and rapid recovery of the joint and body with the close interlocking nailing to be treatment of fresh extremity shaft fracture. It is a perfect method, however the complication should be pay more attention.