肱骨分叉交锁髓内钉的研制和临床应用

目的：介绍肱骨分叉交锁髓内钉（BLIN）的设计和应用情况。方法：在基于国人肱骨髓腔解剖学研究而设计的BLIN远端行分叉自锁，可双向插钉，1998年12月－2000年4月临床应用54例54侧，资料完整的48例，肱骨干骨折47例（陈旧性骨折，骨不连7例），外科颈骨折1例。结果：骨折愈合时间平均为术后18周，1年以上随访发现42例术肢关节功能良好。5例顺插钉和1例逆插钉患者有肩或肘关节活动轻度受限和酸感。结论：分叉自锁免除了常规交锁的繁杂操作，其坚强－动态固定的有机结合有利于骨折愈合，双向插钉使BLIN适用于肱内较大区域内的骨折，BLIN的最佳适应证为复杂型肱骨骨折，强调术后早期活动肩，肘关节。

Design and clinical application of branch locking intramedullary nails in treatment of humeral fractures

Objective To report the design and clinical application of branch locking intramedullary nails (BLIN) in the treatment of humeral fractures. Methods Based on the anatomical study, the authors developed BLIN which could be used in the fractural humeri. Its distal end was locked by the branch which propped up the humeral medullary cavity. BLIN was used clinically from December 1998 to April 2000. The data of 48 cases were complete. There were 7 cases of non unions and old fractures. Closed manner and open reduction had been used. Results Examination for patients and X ray photographs showed fracture healing in 48 cases who were examined in 10 28 weeks (average 18 weeks) after operations separately. Flexion and abduction were not very satisfactory in shoulder or elbow joints in 6 cases, but the functions of shoulder or elbow joints were excellent in the others. Conclusions The manner of branch locking can be used to avoid complicated manipulation and injury in the operation and belongs to a kind of combination of stable and elastic dynamic fixation which is beneficial to fracture healing. Two entrances of the nail putting make BLIN suitable for humeral fractures in a wider region. The best indication in which BLIN can be used is complex humeral fracture. The active movements of shoulder and elbow joints must be advocated even in the early period after operation.