应用尺桡骨交锁髓内钉治疗前臂粉碎性骨折

目的 探讨应用交锁髓内钉治疗前臂尺桡骨粉碎性骨折的可行性与疗效.方法 应用Smith-Nephew公司生产的尺桡骨交锁髓内钉治疗前臂粉碎性骨折29例.结果 术后随访6～36个月,骨折愈合时间8～14周,平均11.2周.术后1例骨折延迟愈合,1例锁钉钉道感染,取钉后愈合,所有患者均未发生骨不连.按Anderson评分标准评定:优18例,良9例,可2例.术后肘关节伸屈活动功能丧失0°～20°,平均10.2°,前臂旋前功能丧失5°～15°,平均9.9°,前臂旋后功能丧失5°～15°,平均11.2°.结论 应用交锁髓内钉固定方法是治疗尺桡骨骨折的较好方法.     

交锁髓内钉固定治疗尺、桡骨粉碎性骨折

目的介绍应用交锁髓内钉固定治疗前臂尺桡骨粉碎性骨折的经验。方法对2 1例尺桡骨骨折,按AO分型[1] B3 型8例、C1型10例、C2 型3例,采用骨折复位、Smith Nephew交锁髓内钉固定术。结果术后随访6～3 6个月,骨折愈合时间8～2 0周,平均16.2周。术后1例骨折延迟愈合,1例锁钉钉道感染,拔钉后愈合,无1例发生骨不连。按Anderson评分标准评定优10例,良7例,可4例。肘关节伸屈活动功能丧失10°～3 5°,平均18.5°,前臂旋前功能丧失15°～5 5°,平均2 5 .0°,旋后功能丧失15°～45°,平均3 3 .5°。结论应用交锁髓内钉固定方法是治疗前臂软组织损伤同时伴有尺桡骨粉碎性骨折的良好手术选择。     

Sanatmetal前臂髓内钉微创治疗尺桡骨骨干骨折

目的探讨应用Sanatmetal前臂髓内钉治疗尺桡骨骨干骨折的手术疗效。方法2005年7月~2007年3月,应用Sanatmetal前臂髓内钉治疗尺桡骨骨干骨折32例;其中男18例,女14例;年龄26~71岁,平均42岁。前臂尺、桡骨双骨折17例,尺骨骨折7例,桡骨骨折8例。32例中多段骨折7例,陈旧性骨折骨不连2例。结果术后随访3~21个月,平均7个月。术后无一例发生伤口感染及髓内钉断裂或松动。32例均完全骨性愈合,愈合时间平均为4个月。按Anderson评分标准评定:优28例,良4例。肘关节伸屈活动功能丧失5~30°,平均17.5°,前臂旋前功能丧失10~35°,平均21.6°,旋后功能丧失10~40°,平均27.5°。结论应用Sanatmetal前臂髓内钉治疗尺桡骨骨干骨折,具有手术损伤小,固定牢固等优点,是治疗前臂骨折较理想的手术方法。     

有限切开前臂交锁髓内钉治疗尺桡骨粉碎性骨折

目的探讨应用交锁髓内钉治疗前臂尺桡骨粉碎性骨折的可行性与疗效。方法对15例AO分类B型与C型尺桡骨骨折的患者应用Smith-Nephew交锁髓内钉的方法进行有限切开、复位内固定。结果根据Anderson评分标准,优8例,良5例,可2例,平均骨折愈合时间6～10周,平均8.4周,延迟愈合1例,无骨不连与感染发生,肘关节活动范围丧失10°～30°,丧失15.5°,前臂旋前功能丧失15°～50°,平均20.6°,前臂旋后功能丧失20°～40°,平均31.2°。结论采用有限切开交锁髓内钉的方法是治疗前臂粉碎性骨折的良好选择。     

Sanatmetal前臂髓内钉微创技术临床应用

目的探讨应用Sanatmetal前臂髓内钉治疗尺桡骨骨干骨折的手术疗效。方法2005年7月至2007年3月，应用Sanatmetal前臂髓内钉治疗前臂骨折32例，其中男18例，女14例；年龄26～71岁，平均42岁。前臂尺、桡骨双骨折17例，尺骨骨折8例，桡骨骨折7例。32例中多段骨折7例，陈旧性骨折骨不连2例。结果术后随访3～21个月，平均7个月。术后无病例发生伤口感染及出现髓内钉断裂或松动，32例患者均完全骨性愈合，愈合时间平均为4个月。按Anderson评分标准评定，优28例，良4例。肘关节伸屈活动功能丧失5°～30°，平均17．5°；前臂旋前功能丧失10°～35°，平均21．6°；旋后功能丧失10°～40°，平均27．5°。结论应用Sanatmetal前臂髓内钉治疗尺桡骨骨干骨折．具有手术损伤小、固定牢固等优点，是治疗前臂骨折较理想的手术方法。     

弹性髓内钉治疗大龄儿童尺桡骨双骨折

目的应用弹性髓内钉治疗大龄儿童（〉9岁）尺桡骨双骨折,观察临床疗效、放射学结果及前臂功能恢复情况。方法采用弹性髓内钉经皮插入技术治疗尺桡骨双骨折13例,年龄9～15岁,平均11.3岁,随访4～14个月,平均随访9个月。结果随访病例全部骨性愈合,愈合时间为2～5个月,平均3.5个月,前臂活动功能优良,无术中及术后并发症发生。结论应用弹性髓内钉内固定治疗大龄儿童尺桡骨双骨折,安全、微创、方便可行,骨折愈合快,并发症少,可尽早恢复前臂活动功能。     

微创弹性髓内钉治疗儿童桡骨颈骨折17例临床观察

目的 探讨微创弹性髓内钉治疗儿童桡骨颈骨折的疗效.方法 回顾性研究17例儿童桡骨颈骨折弹性髓内钉的治疗.分析桡骨颈的解剖特点、C型臂X线透机视下撬拨复位、桡骨远端小切口弹性钉固定手术操作要点及优点.结果 患者均获得随访,时间6～24个月.X线愈合时间9～14周,平均11.5周.无畸形愈合及不愈合病例.1例钉尾磨破皮肤,拔钉后愈合.按照肘关节功能HHS评分标准评定前臂旋转功能,旋前均大于90°,旋后均大于60°,评定结果为优.结论 经皮撬拨复位弹性髓内钉治疗儿童桡骨颈骨折创伤小、并发症少等优点.     

髓内钉固定治疗桡骨远端骨折的疗效

目的 探讨髓内钉固定治疗桡骨远端骨折的临床疗效。方法 采用髓内钉固定治疗40例桡骨远端骨折患者。记录手术时间、术中出血量、骨折愈合时间、并发症发生情况、关节活动度、DASH上肢功能评分。结果患者均获得随访,时间12～18个月。手术时间55～70(64.6±3.2)min,术中出血量25～40(34.7±5.3)ml,骨折愈合时间3～8(4.8±2.6)个月。术后4例出现桡神经浅支损伤,经治疗后皮肤感觉恢复正常,无肌腱损伤、腕管综合征、骨不连等并发症发生。末次随访时,腕关节掌屈25°～70°、背伸50°～90°、桡偏15°～30°、尺偏20°～35°,前臂旋前80°～90°、旋后50°～90°;DASH上肢功能评分0～9(6.5±2.4)分,其中优38例,良2例。结论 髓内钉固定治疗桡骨远端骨折具有创伤小、出血少、并发症少、患者腕关节功能恢复好等优点。     

弹性髓内钉微创闭合复位内固定治疗小儿尺桡骨干骨折76例

目的 探讨弹性髓内钉经皮微创闭合复位内固定在儿童尺桡骨干骨折治疗中的临床效果。方法 对2020年1月-2022年3月收治的儿童尺桡骨骨折76例,均使用闭合复位经皮微创弹性髓内钉内固定方法治疗。结果 术后76例患儿均获得随访,随访时间3～9个月,骨折均愈合,未发生桡神经损伤、骨折不愈合、再次骨折等情况。结论 弹性髓内钉闭合复位内固定治疗儿童尺桡骨干骨折是一种较好的内固定方式,创伤小,恢复快,效果满意。     

前臂交锁髓内钉治疗尺桡骨多段骨折

目的探讨交锁髓内钉治疗前臂多段骨折效果。方法对11例尺桡骨多段骨折采用闭合复位交锁髓内钉固定。结果术后随访6~15个月。骨折愈合时间为12~22周,术后1例延迟愈合,无感染及骨不连。按Anderson评分:优8例,良2例,可1例。结论交锁髓内钉固定是治疗前臂多段骨折的良好方法。     

Intramedullary fixation for pediatric unstable forearm fractures

Forty-nine children with diaphyseal both-bone forearm fractures were treated with either both-bone intramedullary wire fixation (24), single ulnar intramedullary wire fixation (22), or single radial intramedullary wire fixation (3). Six fractures were open and 43 were closed. A limited open approach to one or both bones was necessary for insertion of the intramedullary wire in 10 of 43 closed fractures. All both-bone and single radial intramedullary wire fixations healed with less than 5 degrees angulation. Progressive reangulation of the nonfixed radial fracture after an initial satisfactory reduction was seen in seven of the 22 fractures treated with single ulnar intramedullary wire fixation. In four patients, the reangulation was controlled by a change of cast and molding of the fracture and was between 8 degrees and 12 degrees at union. In two other patients a second operative procedure was required to reduce and internally fix the radius. One fracture healed with a radial angulation of 25 degrees. Three fractures in older patients showed late reangulation after early removal of intramedullary wires at 5 weeks. The results of the current study suggest that the radius and ulna should be stabilized with intramedullary wires and that the wires should be buried to reduce the need for early removal.     

尺、桡骨交锁髓内钉的设计与临床应用

目的 探讨尺、桡骨交锁髓内钉固定系统的临床应用效果.方法 尺、桡骨髓内钉系截面为圆形的实心直金属棒,其直径可分为3.5 min、4.0 mm、4.5 mm和5mm等规格,锁孔直径为2.7 mm;配有扩髓器和瞄准器.2001年8月至2005年7月,采用交锁髓内钉治疗尺、桡骨骨折、骨不连患者31例,男26例,女5例;年龄20～72岁,平均40.2岁.单纯尺骨骨折6例,单纯桡骨骨折6例,孟氏骨折5例,盖氏骨折1例,尺、桡骨双骨折10例,尺骨骨折术后骨不连3例.结果 31例均获随访,随访时间2～6年,平均4.3年.根据Hertel前臂骨折愈合分类,28例骨折愈合(包括3例骨不连患者),愈合时间10～17周,平均14.2周;2例骨折延迟愈合;1例骨不连.根据Anderson等前臂骨折功能评价标准:26例为优,2例为满意,2例为不满意;1例为失败(术后6个月桡骨骨不连,予加压钢板内固定和植骨治疗,骨折愈合).尺、桡骨交叉愈合1例,桡神经浅、深支损伤各1例,无髓内钉松动、断裂及切口感染.27例取出内固定,未发生再骨折;4例因患者原因内固定未取出.结论 尺、桡骨交锁髓内钉固定可用于治疗单纯尺骨或桡骨十骨折、尺、桡骨双骨折、骨不连等前臂骨折,具有创伤小、恢复期短、再骨折率低等优点.     

前臂交锁髓内钉治疗尺桡骨粉碎骨折的临床研究

目的探讨应用前臂交锁髓内钉治疗尺桡骨粉碎性骨折的可行性及其疗效。方法应用前臂交锁髓内钉采用切开或闭合复位技术治疗尺桡骨粉碎性骨折18例,男15例,女3例;年龄32～63岁,平均42岁。骨折按AO分型,A 1型4例,A 2型1例,A 3型2例,B 2型1例,B 3型3例,C 2型3例,C 3型4例。手术均在伤后1周内进行。结果所有病例术后随访8～10个月,骨折愈合时间8～16周,平均12周。所有患者均未发生骨不连、术后感染及桡神经深支损伤病例;术后有2例前臂旋转功能恢复欠佳,1例骨折延迟愈合,其余患者功能恢复满意。根据B erton评定标准进行评价,优10例,良5例,可2例,差1例,优良率为83.3%。结论应用前臂交锁髓内钉技术治疗尺桡骨骨折,具有手术创伤小、固定牢靠、骨折愈合率高、功能恢复快等优点,是治疗前臂骨折较理想的手术方法,尤其适用于多段骨折、粉碎性骨折。     

Intramedullary fixation of pediatric forearm diaphyseal fractures

Surgical treatment of pediatric forearm fractures is controversial. In this retrospective study, we reviewed 24 skeletally immature radial and ulnar fractures in 24 patients treated with intramedullary Rush pins and/or Kirschner wires between 1994 and 1999. The indication for surgical intervention was unacceptable closed reduction, unstable fracture pattern, open fracture, or recurrence after nonsurgical treatment. For each patient, a sugar tong splint was used for 4 weeks, and pins were removed 8 weeks after surgery. Average length of follow-up was 32 months (range, 6-58 months). All fractures in this series healed. Average time to union was 8 weeks. There were no complications of delayed union, nonunion, infection, or neurovascular injury. All patients regained full range of motion of the injured extremity.     

Paediatric forearm fractures: the increasing use of elastic stable intra-medullary nails

This paper entails a clinical review of outcomes and complications of 19 consecutive paediatric patients having undergone elastic stable intramedullary nailing for diaphyseal forearm fractures over a one year period. The mean age of patients was 9 years. The majority were male with a ratio of 17:2. In this group there were two patients with grade 1 open fractures. Four of the fractures required open reduction due to difficulty in reduction and soft tissue interposition. All fractures went on to osseous union with minimal deformity and full recovery. There were three complications which included one EPL rupture requiring delayed repair, one EPB partial rupture repaired at time of surgery, and one superficial radial nerve injury. Two patients also presented with nails penetrating the skin prior to removal. Elastic stable intramedullary nails offer good fixation to control deformity in midshaft forearm fractures for paediatric patients. However there is a high rate of possible complications around the radial insertion point.     

Screw elastic intramedullary nail for the management of adult forearm fractures

Background:

The failure of the conventional nailing of both forearm bones or isolated fractures of radius and ulna pose a potential problem of nail migration and rotational instability, despite the best reduction. The purpose of this paper is to evaluate the results of screw elastic intramedullary nail for the treatment of adult diaphyseal fractures of both forearm bones, which effectively addresses the problems associated with the conventional nailing systems for the forearm fractures.

Materials and Methods:

Seventy-six adults with forearm fractures (radius and ulna or isolated fracture of the single bone) were retrospectively evaluated. Fifty males and 26 females with the mean age of 38 years (range, 18-70 years) underwent closed reduction and screw intramedullary nail fixation. Ten patients required limited open reduction. The fractures were classified according to the AO/OTA system. The average followup was 12 months (range, 6 to 18 months).

Results:

The mean surgical time was 45 minutes (35 to 65 minutes). The meantime to union was 14 weeks (10-21 weeks). The results were graded as excellent in 50, good in 18 patients, and acceptable in eight patients, using the criteria of Grace and Eversman. We had superficial infection in three cases, one case of delayed infection, painful bursa in two cases, delayed union in two cases, malunion with dislocation of the DRUJ in two cases, injury to the extensor tendon of the thumb in one case, and one case of incomplete radioulnar synostosis.

Conclusion:

Closed reduction and internal fixation of forearm fractures by screw intramedullary nails reestablishes the near normal relationship of the fractured fragments. Screw intramedullary nail effectively controls both rotatory forces and the migration of the nail. It produces excellent clinical results in isolated fractures of either bones, as well as both bones of the forearm in adults.     

肱骨交锁髓内钉治疗肱骨干骨折不愈合

目的探讨交锁髓内钉在治疗肱骨骨折不愈合中的应用和临床效果。方法对21例肱骨干骨折经治疗后不愈合（钢板内固定16例,外固定架固定2例,保守治疗3例）病例进行了原内固定取出、交锁髓内钉固定及自体髂骨植骨手术,21例中原发桡神经损伤11例。结果手术时间95～180min（平均135min）,术中出血量260-580mL（平均380mL）,术中出现1例医源性桡神经损伤,经保守治疗2个月后恢复。未发生其他血管损伤、髓腔感染、断钉及血栓形成等并发症。随访7～24个月,21例中19例在术后12～20周内愈合。2例出现延迟愈合,经进一步保守治疗分别在术后25周和33周愈合,此2例均为原发桡神经损伤较重者。肩关节功能按Neer评分,优17例,良3例,一般1例。结论交锁髓内钉固定同时行白体髂骨植骨治疗肱骨干骨折不愈合具有疗效好、并发症少及取内固定手术简单等优点,是一种较理想的治疗方法。     

Intramedullary wire fixation for unstable forearm fractures in children

Displaced fractures of the diaphyseal forearm in children are often treated conservatively, but there is relatively high incidence of redisplacement, malunion and consequent limitation of function. This retrospective study was performed to determine means for minimalising the complications of intramedullary Kirschner (K)-wire fixation used in the treatment of unstable, diaphyseal forearm fractures by pointing out those which most frequently occur with this treatment choice. This treatment method was applied in 48 children with a mean age of 10.3 (range, 5-14) years. A limited open reduction to one or both bones was necessary for insertion of the intramedullary wire in 20 (40%) patients. Although 24 complications, such as pin site infection, loss of forearm rotation, superficial branch of radial nerve palsy, delayed union, nonunion, hardware migration, and K-wire penetration to the opposite cortex, were recorded in 18 patients, 46 patients (96%) had excellent or good, 1 patient (2%) had fair and 1 patient (2%) had poor outcome using the grading scheme adapted by Price. Except for the patient in whom the fracture was not united, the average union time was 6.3 weeks in children less than 10 years and 7.8 weeks in those above 10 years of age. Despite these minor complications, percutaneous intramedullary fixation with K-wires and proper technique is an appropriate, effective and safe operation for unstable diaphyseal fractures of the forearm in children who cannot be treated by closed manipulation.     

Acumed前臂髓内钉治疗成人前臂双骨折

目的 :探讨Acumed前臂髓内钉治疗成人前臂双骨折的临床疗效。方法:2009年1月至2016年12月采用Acumed髓内钉治疗成人前臂双骨折患者86例,男54例(62.8%),女32例(37.2%),年龄18~72岁,平均36.8岁;右侧50例,左侧36例。记录病例手术时间、术中出血量、放射暴露时间、骨折愈合时间、并发症,DASH问卷调查(Disabilities of the Arm,Shoulder and Hand questionnaire)和Grace-Eversman疗效评级以评估髓内钉治疗前臂骨折的临床效果。结果:86例患者均获随访,随访时间48~144周,平均86.8周;术中出血量30~80 ml,平均52 ml;放射性暴露时间1~6 min,平均2.5 min;手术时间31~55 min,平均46 min。85例骨折顺利愈合,愈合时间10~16周,平均13.3周。3例患者出现并发症,其中1例肥大性骨不连,1例尺桡骨间骨桥形成,1例拇长伸肌腱损伤。DASH评分0~28分,平均15.6分;Grace-Eversman评价结果,优65例,良15例,可5例,差1例。结论:前臂髓内钉用于治疗成人前臂双骨折具有微创、手术时间短、并发症少等优点,临床效果满意。     

弹性髓内针治疗儿童长骨骨折

目的探讨弹性髓内针固定治疗儿童长骨骨折的并发症及预后。方法回顾性总结我院2004年1月至2010年5月收治的47例儿童非粉碎性长骨骨折,包括肱骨骨折、尺骨桡骨骨折、股骨骨折、胫骨骨折。47例患儿中,男性27例,女性20例;年龄6~14岁。肱骨骨折6例,尺桡骨骨折20例,股骨骨折15例,胫骨骨折6例。对于尺桡骨骨折,采用麻醉下闭合复位,单根弹性髓内针固定,石膏固定2~3周后自主活动。对于肱骨、股骨、胫骨骨折,采用麻醉下闭合复位,双根弹性髓内针交叉固定。肱骨骨折后石膏固定3周后自主活动;股骨、胫骨骨折石膏固定5~6周,8~10周后完全负重行走。结果 47例患儿经弹性髓内针内固定治疗后,骨痂生长良好,均获治愈,并且关节功能恢复正常,无严重的并发症。结论术前合理选择患儿年龄、骨折类型,采用弹性髓内针治疗儿童长骨骨折,具有微创、安全、简便、复位好、恢复快和并发症少的优势。