分叉式交锁髓内钉治疗肱骨干复杂骨折

用分叉交锁髓内钉治疗复杂肱骨骨折 (多段骨折、长斜形骨折 ,长段粉碎性骨折 ) 1 0例 ,其中闭合复位 2例 ,小切口复位 8例 ,均为顺行穿钉。根据骨折愈合、术后肩关节功能恢复进行评价。结果 1 0例骨折全部愈合 ,肩关节功能优 4例 ,良 5例 ,差 1例。分叉式交锁髓内钉是治疗肱骨干复杂骨折较理想的方法     

交锁髓内钉治疗肱骨干骨折的围手术期护理

总结了18例交锁髓内钉治疗肱骨干骨折的围手术期护理方法。认为术前做好心理护理；术后密切观察病情，正确指导病人进行早期、有效、循序渐进的功能锻炼可使关节早日康复。     

交锁髓内钉固定术治疗肱骨干中段骨折的疗效分析

目的:分析交锁髓内钉固定术治疗肱骨干中段骨折的疗效。方法:选取本院2014年5月~2017年5月收治的64例肱骨干中段骨折患者为研究对象,依据手术方案不同分成对照组和实验组各32例。对照组行锁定加压钢板固定术治疗,实验组行交锁髓内钉固定术治疗,对比两组手术效果、术后并发症及肩关节功能恢复效果。结果:实验组手术时间、出血量、骨折愈合时间、并发症发生率等指标均明显低于对照组(P0.05);实验组肩关节功能恢复优良率高于对照组(P0.05)。结论:肱骨干中段骨折行交锁髓内钉固定术治疗疗效确切,且并发症少,患者肩关节功能恢复效果好,临床价值显著。     

微创顺行交锁髓内钉内固定治疗肱骨干骨折

目的探讨分析微创顺行交锁髓内钉内固定治疗肱骨干骨折的临床应用效果。方法我院自2003年8月至2007年10月采用微创顺行交锁髓内钉内固定治疗肱骨干骨折患者39例，均为新鲜闭合骨折；术后三角巾悬吊制动2～3周，4周后适当加大功能锻炼幅度。结果39例患者均随访6个月至2年，平均15个月，均达到骨性愈合，无1例出现神经损伤症状、骨不连及延迟愈合。结论微创顺行交锁髓内钉内固定治疗肱骨干骨折的治疗效果确切，手术切口小，骨折处无需切开复位，无需剥除骨折处的骨膜，对骨折周围的血管及神经的损伤小，并发症少。     

顺行分叉交锁髓内钉治疗肱骨干骨折

肱骨干骨折约占人体骨折总数的1．31％，治疗不当易造成骨折不愈合。1999年4月至2003年12月，本科采用分叉交锁髓内钉治疗肱骨干骨折28例．取得满意效果。报告如下。     

交锁髓内钉治疗肱骨干骨折（附27例报告）

目的：报道交锁髓内钉在肱骨干骨折的临床运用。方法：在27例成人肱骨干骨折运用小切口交锁髓内钉内固定。结果：27例骨折均骨性愈合，功能无受限。结论：此方法操作简单，术后并发症少，是治疗肱骨干骨折的有效方法。     

微创逆行交锁髓内钉治疗肱骨干骨折

肱骨干骨折占全身骨折约3％,多由直接暴力所致,治疗上大多数采用非手术治疗,对于有手术指征的病例,手术方式有接骨板固定,交锁髓内钉固定等。作者自2005年12月至2008年11月对12例肱骨干骨折患者采用了微创逆行交锁髓内钉治疗,并进行了回顾性分析,结果显示采用该种手术方法治疗肱骨干骨折具有创伤小、固定稳固、骨折愈合快、对肩、肘关节功能影响小等优点。现总结如下。     

交锁髓内钉治疗肱骨干骨折30例

肱骨干骨折约占全身所有骨折的1%。大多数肱骨干骨折可通过非手术方法获得满意的疗效。自20世纪40年代德国Kunscher发明髓内钉以来,髓内钉技术有了充分的发挥及广泛的应用。现在的交锁髓内钉技术治疗长管状骨骨折已成为一种大趋势。交锁髓内钉治疗肱骨干骨折具有手术创伤小、并     

闭合复位交锁髓内钉治疗肱骨干粉碎骨折

长骨骨折后的髓内固定近半个世纪中,固定操作技术和材质的改正,均有很大的进展,硬质交锁钉因其坚强的稳定性和可靠的治疗效果已取代了软质、半硬质钉,在治疗肱骨干粉碎骨折中显示出优势.而闭合骨折固定,采用了微创生物学接骨术原则,其软组织损伤少,骨愈合率高.本院自2000年11月至2003年10月,应用闭合复位顺利置入髓内钉治疗肱骨干粉碎骨折16例,均获得良好愈合,取得了满意的效果,现报告如下.     

交锁髓内钉治疗胫骨骨折

目的探讨交锁髓内钉治疗胫骨骨折的疗效及并发症的防治。方法切开复位，静力型交锁髓内钉固定治疗胫骨骨折40例；闭合复位，静力型交锁髓内钉固定治疗胫骨骨折5例。结果42例获得一期愈合，3例延迟愈合。结论交锁髓内钉治疗胫骨骨折，尤其是粉碎性骨折理想的内固定方法，关节功能恢复理想。     

带锁髓内钉治疗胫骨中下段骨折60例护理体会

目的：探讨带锁髓内钉治疗胫骨中下段骨折的护理方法。方法：对60例患者进行术前心理护理、术中密切配合、术后加强护理，加强功能锻炼。结果：本组均临床愈合，达到预期目的。结论：根据患者的不同情况选择适当的护理方法，对手术的成功和患者的康复有重要意义。     

带锁髓内钉治疗胫骨中下段骨折60例护理体会

目的:探讨带锁髓内钉治疗胫骨中下段骨折的护理方法。方法:对60例患者进行术前心理护理、术中密切配合、术后加强护理,加强功能锻炼。结果:本组均临床愈合,达到预期目的。结论:根据患者的不同情况选择适当的护理方法,对手术的成功和患者的康复有重要意义。     

髓内钉内固定治疗肱骨干骨折的远期效果

目的：观察髓内钉内固定治疗肱骨干骨折的远期疗效。方法：对31例肱骨干中、下段骨折施行切开复位髓内钉内固定术，手术时年龄15～67岁，平均37．7岁。29例得到随访，平均随访7年(1年4个月～10年)。根据临床表现和X线征象评定疗效，分析其远期效果。结果：根据韩一生等肩、肘关节活动度标准，优27例、良2例，总优良率100％。结论：髓内钉内固定治疗肱骨干骨折有术式简单、损伤小、疗效好、符合生物力学要求等优点，值得推广应用。     

解剖型钢板和锁定加压钢板治疗多部位肱骨外科颈骨折比较分析

目的 探讨解剖型钢板和锁定加压钢板在肱骨外科颈骨折治疗中的应用效果.方法 选取肱骨外科颈骨折患者51例,随机分为2组,解剖型钢板组35例,锁定加压钢板组16例.应用解剖型钢板治疗肱骨外科颈骨折35例,根据Neer分类法,Neer三部分骨折19例,四部分骨折16例;锁定加压钢板治疗肱骨外科颈骨折16例,Neer三部分骨折9例,四部分骨折7例.结果 解剖型钢板组28例获随访,时间4～48个月,平均(21±2)个月.按Constant评分标准,优19例,良8例,可1例;锁定加压钢板组14例均获随访,时间1～24个月,平均(12±1)个月.术后肩关节功能评分,优10例,良4例.结论 解剖型钢板和锁定加压钢板均是治疗肱骨外科颈骨折较理想的方法.

Abstract：

Objective To compare the therapeutic effect of anatomy plate and locking compression plate in the treatment of humerus surgical neck fracture. Methods Fifty one patients with humerus surgical neck fracture were enrolled into the study and divided into two groups randomly to accept anatomy plate or locking compression plate treatment. In the anatomy plate treatment group ( n = 35 ), 19 cases were type- Ⅲ fractures and 16 cases were type-Ⅳ fractures according to Neer classification. In the locking compression plate treatment group (n = 16) ,9 cases were type-Ⅲ fractures and 7 cases were type-Ⅳ fractures according to Neer classification. Results In anatomy plate group,28 cases were followed up for 4 months to 48 months ( average period was [21 ± 2] months). According to the Constent score criteria, 19 cases got excellent outcome,8 cases got good outcome,1 case got fair outcome. In locking compression plate group, 14 cases were followed up for 1 month to 24 months (average period was[12 ± 1] months). Ten cases got excellent outcome,4 cases got good outcome. Conclusion Both anatomy plate and locking compression plate treatments are good for the humerus surgical neck fracture.     

旋入式自锁钉及经皮自体骨髓移植微创治疗肱骨骨折

目的 观察旋入式自锁钉及自体骨髓移植治疗肱骨干骨折的临床效果,探讨肱骨干骨折的微创治疗方法.方法 回顾性分析自2003年4月至2006年3月微创法治疗肱骨骨折36例,其中闭合骨折30例,其中开放性骨折6例;单纯旋入式自锁钉固定11例,旋入式自锁钉加自体骨髓移植25例.肩部小切口,术中均不扩髓,术后不用外固定,并早期能锻炼;自体骨髓移植时间以术后1～2月内1次,可2～3次,不住院.结果 经6～18个月术后随访,骨折全部愈合,平均愈合时间8个月,其中加用自体骨髓移植比单纯使用自锁钉骨折愈合时间提前两个月左右.肩、肘关节功能无明显障碍,上肢功能恢复正常.结论 旋入式自锁钉治疗肱骨骨折,固定可靠,可不扩髓,联合使用经皮自体骨髓移植,可促进骨折愈合,缩短骨折愈合时间;两种治疗方法操作简单,创伤小,骨折愈合快,功能恢复好,是微创治疗肱骨干骨折的有效方法.     

逆行交锁髓内钉治疗股骨远端骨折疗效评价

目的 评价小切口复位逆行交锁髓内钉治疗股骨远端骨折的临床效果.方法 对24例股骨远端骨折采用小切口复位逆行交锁髓内钉内固定治疗的病例进行回顾性分析.按股骨远端骨折AO/ASIF分类,A型16例,C型8例.结果 本组病例随访时间6～24个月(平均17.4个月),平均愈合时间为4.6个月,无术后感染,1例远端锁钉断裂,经制动后骨折愈合.按Neer等膝关节评分标准进行评价,优15例,良6例,优良率87.5%.结论 小切口复位逆行交锁髓内钉治疗股骨远端骨折,手术操作简单,固定可靠,对软组织破坏少,骨折愈合率明显提高,用于治疗股骨远端复杂骨折手术效果好.     

股骨近端髓内钉InterTAN和股骨近端抗旋髓内钉治疗不稳定型股骨转子间骨折的临床回顾研究

目的回顾分析股骨近端髓内钉Inter TAN和股骨近端抗旋髓内钉(PFNA)治疗不稳定型股骨转子间骨折的临床效果和手术并发症。方法选取我院自2012年1月至2013年8月手术治疗的不稳定型股骨转子间骨折患者57例,按照AO分型,A2型43例,A3型14例。分别采用Inter TAN(34例)和PFNA(23例)内固定,比较两组之间的临床效果、手术损伤和手术并发症。结果术后切口均Ⅰ期愈合,无感染及皮肤坏死等早期并发症发生。手术时间:Inter TAN组(26.1±11.5)min,PFNA组(24.2±15.5)min,无统计学差异(t=1.227,P=0.246);术中出血量:Inter TAN组(76.3±30.7)ml,PFNA组(71.5±38.5)ml,无统计学差异(t=1.362,P=0.185);术中透视次数:Inter TAN组(19.5±5.9)次,PFNA组(16.1±6.1)次,无统计学差异(t=1.779,P=0.086);总计49例获得随访,其中Inter TAN组29例,PFNA组20例,随访时间(15±4.6)个月。骨折临床愈合时间:Inter TAN组(10.6±2.8)周,PFNA组(11.2±3.5)周,无统计学差异(t=0.860,P=0.392);髋关节功能评分(Harris评分法):Inter TAN组(86.7±5.4)分,PFNA组(88.5±7.6)分,无统计学差异(t=0.712,P=0.455);术后并发症:Inter TAN组出现1例髋内翻和2例下肢深静脉血栓(并发症发生率10.3%);PFNA组出现1例髋内翻和1例下肢深静脉血栓(并发症发生率10.0%),两组并发症发生率比较无统计学差异(χ2=0.001,P=0.990)。结论 Inter TAN和PFNA均具有手术时间短、术中透视次数少、术中出血量少和术后并发症发生率低的优点,两者均适用于不稳定型股骨转子间骨折病例。     

可膨胀髓内钉结合自体骨移植治疗肱骨干骨不连

目的探讨可膨胀髓内钉FixionTM系统结合自体骨移植在肱骨干骨不连中的应用和临床疗效方法对11例肱骨干中1/3骨折骨不连病人采用可膨胀髓内钉FixionTM系统结合自体骨移植进行治疗,8例有钢板内固定手术史,其中2例骨质明显疏松,1例存在桡神经麻痹。结果手术时间63~115min（平均87min）;术中出血量120~250ml（平均180ml）;11例骨不连均痊愈（平均愈合时间17周）。结论可膨胀髓内钉FixionTM系统结合自体骨移植是治疗肱骨干骨折骨不连比较理想的方法,尤其适用于骨质疏松病人。     

颅面分离的外科治疗

目的：探讨颅面分离的诊断与外科治疗。方法：回顾性研究1995年10月至2000年10月诊治的28例颅面分离病人的临床资料和外科治疗方法。结果：28例病人中21例为外伤性颅面分离，7例为非外伤性颅面分离。外伤患者中有眼眶并发症者37例次，颅内并发症者29例次，其中脑脊液鼻漏占42．9％。外伤者骨折复位固定术式为经面部创口进路者9例，经面中部掀翻进路4例，颅面联合进路4例，多切口骨膜下隧道贯通进路4例。非外伤性颅面分离者均在切除颅底沟通瘤时一期进行了颅面骨的固定与颅面分离的修复。结论：颅面分离是颅面外科一种特殊类型疾病，采用适宜的外科手术方法进行治疗，能够取得良好的治疗效果。     

Intramedullary fixation of humerus shaft fractures. An analysis of complications of 2 implants with special reference to outcome after management with the unreamed humerus interlocking nail

INTRODUCTION: Operative treatment of humeral shaft fractures has gained a new impetus with the development of intramedullary interlocking systems for the humerus. Because of the anatomical structure of the humeral marrow cavity, a regular jamming of nail into bone is not to be expected, so that the stability of these systems needs to be achieved through an interlocking mechanism. Among the commercially available interlocking nailing systems the unreamed humeral nail (UHN) and the Seidel-nail (SHN) can be regarded as the standard implants. DESIGN: In a retrospective study comparing two groups of patients, each treated with one of the two systems, problems and advantages, as well as disadvantages were analyzed, and the complications inherent in the systems examined. PATIENTS: Between 1988-1992, 47 patients with humeral shaft fractures were treated with a Seidel interlocking nail: 25 acute and 18 pathological fractures as well as 4 non-unions (Group 1). Between 1997-1999, 34 patients with humeral shaft fractures were treated with the unreamed humeral nail (UHN). A total of thirty-five (n = 35) nailings (30 acute and 4 pathological fractures, as well as one re-osteosynthesis after emergence of a non-union) were carried out. Three primary palsies of the radial nerve ensued: two with loss of sensitivity, and one complete paralysis (Group 2). METHODS: Based on pre- and postoperative X-rays and follow-up examinations, the healing process and complications inherent in each of the systems were evaluated. RESULTS: Intra-operative complications of Seidel-nailing (Group 1) were seen in 5 cases: failure of the proximal target device in 2 (4.2%) cases; the breaking of the long screwdriver during the distal locking in 1 (2.1%) case; blockade of nail-insertion due to the spreading distal lamellas in 1 (2.1%) case; in 1 (2.1%) case it was impossible to find the imbus of the distal locking screw with the screwdriver. Incorrect surgical technique resulting in further fragmentation of the shaft required revisions in 2 (4.2%) cases. In 3 cases (6.4%), the insertion of the nail was insufficient, so that an impingement resulted. In 12 cases, postoperative complications after Seidel-nailing resulted: 3 (6.4%) radial nerve palsies, of which 2 (4.2%) were transitory; 3 (6.4%) infections; in 3 (6.4%) cases, loosening of the locking bolt inserted in the frontal plane; in 1 (2.1%) case, loosening of the distal spreading screw. The system failed in treating 2 (of 4) non-unions, whereas successful ossification and repair occurred in all acute fractures. In Group 2 (UHN) the acute fractures of 33 cases healed without complications. Intra-operative complications of the unreamed nail: in 2 cases (5.6%), failure of the target devices resulted in malpositoning of interlocking screws. The following intra-operative complications of the retrograde technique were observed: burst of a fragment at the insertion site in 1 case (2.8%); intra-articular positioning of the most proximal interlocking screw in another case (2.8%). Postoperative complications of the unreamed nail: breaking of a proximal and a distal interlocking screw in 1 case (2.8%), which had no influence on the healing progress. In 1 case (2.8%) both proximal interlocking screws came loose and a non-union ensued. After re-osteosynthesis with the same technique, bony repair was achieved. CONCLUSION: The possibilities of operative methods in treatment of humeral shaft fractures are enhanced by intramedullary interlocking systems. Comparing with the Seidel nail, the unreamed humeral nail (UHN) has two advantages: it can be inserted anterogradely as well as retrogradely, and it provides the possibility of compressing the fracture, resulting in a high rotational stability. Due to these results, the application of the UHN is recommended.