顺行交锁髓内钉与锁定钢板内固定治疗肱骨干骨折疗效比较

目的比较顺行交锁髓内钉与锁定钢板内固定治疗肱骨干骨折的临床疗效。方法回顾性分析自2012-02—2016-03诊治的45例新鲜闭合性肱骨干骨折,26例采用切开复位锁定钢板内固定治疗(钢板组),19例采用闭合复位顺行交锁髓内钉内固定治疗(髓内钉组)。比较2组手术时间、术中出血量、骨折愈合时间,末次随访时肩关节功能Neer评分与肘关节功能Mayo评分,以及并发症情况。结果 45例均获得随访,钢板组随访时间平均20.9(12～36)个月,髓内钉组随访时间平均22.3(12～35)个月。与钢板组比较,髓内钉组手术时间更短,术中出血量更少,但末次随访时肩关节功能Neer评分更低,差异有统计学意义(P 0.05)。钢板组与髓内钉组骨折愈合时间、末次随访时肘关节功能Mayo评分比较差异无统计学意义(P0.05)。钢板组与髓内钉组并发症发生率比较差异无统计学意义(P0.05)。结论对于新鲜闭合性肱骨干骨折,锁定钢板内固定术后患者肩关节功能恢复更好,但手术创伤大、医源性桡神经损伤发生率更高;顺行交锁髓内钉内固定创伤小、生物力学性能优、不易造成桡神经损伤,但术中需切开肩袖而影响术后肩关节功能。     

磁力导航逆行带锁髓内针远端锁钉技术治疗股骨骨折的应用

目的探讨磁力导航逆行带锁髓内针远端锁钉技术治疗股骨中下段骨折的临床疗效。方法 2017年1月～2019年2月收治的股骨中下段骨折病人38例,根据治疗方法不同分为两组,磁力导航锁定髓内针组(A组)16例,使用磁力导航系统进行髓内钉的远端锁定技术治疗;机械瞄准锁定髓内针组(B组)22例,使用机械瞄准方法进行髓内钉的远端锁定技术治疗,比较两组病人术中远端一次性锁定的成功率、手术时间、术中出血量、并发症发生率、骨折愈合率、骨折愈合时间、术后膝关节KOOS评分。结果 A组的远端锁定一次成功率高于B组,手术时间短于B组,术中出血量少于B组,并发症发生率低于B组,术后膝关节KOOS功能评分优良率高于B组,差异有统计学意义(P0.05)。A组骨折愈合率高于B组,骨折愈合时间短于B组,但差异无统计学意义(P0.05)。结论磁力导航逆行带锁髓内针远端锁钉技术治疗股骨中下段骨折锁定时间短,效率高,放射线暴露时间短。     

逆行穿带锁髓内针治疗新鲜肱骨干骨折

目的 总结使用逆行穿带锁髓内针治疗肱骨干骨折的临床经验以提高肱骨干骨折的治疗水平。方法 1999年2月－2000年6月使用逆行穿带锁髓内针的方法治疗肱骨干新鲜骨折32例,骨折均为闭合型,手术采用从鹰嘴窝上向近端逆行穿针法。结果 32例3个月时全部骨性愈合,肩肘关节活动恢复95％以上。1例出现术后桡神经麻痹。结论 逆行穿针避免了对肩袖的干扰,髓内针能有效地稳定骨折,软组织进一步破坏小,肩肘关节功能恢复快。     

闭合复位顺行交锁髓内钉治疗肱骨干骨折

目的 评价采用闭合复位顺行交锁髓内钉治疗肱骨干骨折的临床效果.方法 回顾性分析自2002年5月～2006年1月采用闭合复位顺行交锁髓内钉治疗肱骨干骨折61例,按A0分型A型36例,B型18例,C型7例,均采用闭合复位,扩髓顺行插钉,远近端交锁.结果 61例获得7～28个月的随访,59例骨性愈合,2例骨折延迟愈合,改动力化2个月后获得骨性愈合,平均愈合时间为16.8周,肩关节功能按Neer评分:优53例,良6例,可2例,优良率96.7%,肘关节功能正常.结论 闭合复位顺行交锁髓内钉治疗肱骨干骨折固定牢靠、创伤小、恢复快是一种有效的治疗方法.     

顺行旋入式髓内钉治疗肱骨干骨折疗效观察

目的总结顺行旋入式髓内钉治疗肱骨干骨折的临床疗效。方法24例肱骨干骨折患者采用顺行旋入式自锁髓内钉固定。结果24例均获随访,平均18．6个月,所有患者骨折均愈合,平均愈合时间23．0（21．4—24．7）周。肩关节Constant评分平均82．7（76．9—88．6）分;肘关节Mayo评分平均91．3（89．6—93．1）分;Neer评分：优19例,良5例。结论顺行旋入式髓内钓。固定手术操作简单、时间短、损伤小、术中并发症少、骨折愈合快,适合稳定性骨折和断端非缺损性粉碎性骨折,尤其适用于开放性肱骨干骨折手术。     

肩袖是否缝合对肱骨近端骨折锁定钢板固定术后疗效的分析

[目的]探讨肩袖是否缝合至钢板对肱骨近端骨折锁定钢板固定术后疗效的影响。[方法]回顾分析2010年7月~2013年8月采用锁定钢板治疗的139例肱骨近端骨折患者。按照内侧柱是否完整及肩袖是否缝合至钢板分为A1、A2、B1、B2四组。其中内侧柱完整的肩袖缝合组(A1组)33例,内侧柱完整的肩袖未缝合组(A2组)39例,内侧柱不完整的肩袖缝合组(B1组)32例,内侧柱不完整的肩袖未缝合组(B2组)35例。记录各组骨折愈合时间、肩关节功能评分、颈干角变化及术后并发症,并进行组内比较。[结果]139例患者随访时间12~36个月(平均19个月),A1组、A2组骨折愈合时间、肩关节功能评分、颈干角变化等比较差异无统计学意义(P0.05);B1组、B2组骨折愈合时间比较差异无统计学意义(P0.05),而肩关节功能评分、颈干角变化比较B1组明显优于B2组,差异有统计学意义(P0.05)。A1、A2、B1组未见明显并发症,B2组2例出现螺钉穿出关节面,1例内固定出现松动。[结论]肩袖是否缝合至钢板对内侧柱完整的肱骨近端骨折锁定钢板固定术后均可取得满意的疗效;肩袖缝合至钢板对内侧柱不完整的肱骨近端骨折锁定钢板固定术后,可通过中和肩袖的内翻应力作用,维持术后骨折复位、减少并发症、提高肩关节功能。     

LISS与单切口双钢板支撑内固定治疗复杂胫骨平台骨折疗效比较

目的比较AO微创内固定系统（LISS）与单切口双钢板支撑内固定治疗复杂胫骨平台骨折的疗效。方法将83例SehatzkerV、VI型胫骨平台骨折随机分为2组,A组行单切1：3双钢板支撑内固定治疗,B组行LISS内固定治疗。比较2组骨折复位情况、骨折愈合时间及膝关节功能。结果B组平均骨折愈合时间为（16．7±1．6）周,短于A组平均（19．6±2．0）周;B组并发症发生率11．9％,低于A组的24．4％;差异均有统计学意义（P（0．05）。2组内翻角、后倾角、膝关节活动度、膝关节功能HSS评分比较差异无统计学意义（P〉0．05）。结论UsS与单切I：1双钢板支撑内固定治疗SehatzkerV、VI型复杂胫骨平台骨折,术后膝关节功能均恢复良好;但与单切口双钢板支撑术相比,LISS内固定术后骨折愈合时间短、并发症少。     

交锁髓内钉治疗肱骨多段骨折

目的探讨交锁髓内钉治疗肱骨多段骨折的疗效。方法1998年6月～2005年7月采用交锁髓内钉加钢丝或记忆合金卡环固定治疗32例肱骨多段骨折患者。其中分叉钉固定20例,远端带锁钉固定12例；顺行固定22例,逆行固定10例。结果32例患者术后获8～24个月(平均16个月)随访。31例患者获骨性愈合,愈合率为96．9%。骨折愈合时间为12～48周,平均24．5周。肩关节活动按Neer功能评定法评价：优21例,良6例,可4例,差1例,优良率为84．4%,肘关节活动均正常。结论交锁髓内钉加钢丝固定是治疗肱骨多段骨折的一种较好办法,其固定牢靠,能最大限度地恢复患者肩、肘关节功能。     

前侧入路钢板前置治疗肱骨中下段骨折的解剖研究及临床应用

目的探讨肱骨中下段骨折在不损伤桡神经、不影响屈肘肌力情况下,钢板前置手术入路的手术方式。方法 (1)在10具成人尸体的20侧上肢标本上对肱骨前入路中的神经、血管进行测量。(2) 50例肱骨中下段骨折钢板内固定患者分别采用前外侧入路(A组,20例)和前内侧入路(B组,30例)。比较两组手术时间、术中出血量、骨折愈合时间及Mayo肘关节功能评分(MEPS)、肩关节Neer评分、屈肘肌力,评价疗效。结果手术时间及术中出血量B组少于A组(P 0. 05),骨折愈合时间两组差异无统计学意义(P 0. 05);术后12个月,肩、肘关节功能两组比较差异均无统计学意义(P 0. 05);并发症发生率B组低于A组(P 0. 05)。结论前内侧入路置入钢板治疗能避免损伤桡神经及尺神经,不影响屈肘肌力,且手术时间较短、术中出血量较少,并发症发生率低。     

切开复位内固定术治疗Pilon骨折的手术时机选择

目的探讨切开复位内固定术治疗Pilon骨折的最佳手术时机选择。方法自2008—05－2012—06收治的55例Pilon骨折按手术时机分为2组,A组27例于伤后3—7d行切开复位内固定术,B组28例延期于伤后7—21d待软组织肿胀消退后再进行切开复位内固定术。比较2组骨折愈合时间、术后并发症发生率和踝关节功能。结果A组骨折愈合时间平均（18．7±3．1）周,并发症发生率29．6％;B组骨折愈合时间平均（15．4±2．4）周,并发症发生率7．1％;B组骨折愈合时间少于A组,并发症发生率低于A组,差异有统计学意义（P〈0．05）。末次随访时,A组踝关节功能优良率74．1％,B组踝关节功能优良率89．3％,B组踝关节功能优良率高于A组,差异有统计学意义（P〈0．05）。结论Pilon骨折手术时机的选择对手术效果具有关键的影响,分步延期手术可以缩短骨折愈合时间,改善愈合效果,促进踝关节功能的进一步康复。     

Der „AO/ASIF-Flexnail“

BACKGROUND: The use of conventional implants for intramedullary nailing of humeral shaft fractures is associated with specific difficulties. During antegrade implantation structures of the rotator cuff can be affected leading to a reduced functional result of the shoulder. If the nail is implanted in a retrograde manner problems arise due to a relatively large hole close to or within the olecranon fossa, which is necessary for insertion of the nail. Supracondylar fractures as well as persistent elbow pain and loss of function are reported in the literature. To overcome these disadvantages a flexible nail has been developed that can be stiffened and locked after implantation. METHOD: Between October 2000 and February 2002, 34 patients were treated with the flexible nail at our institution; 29 were available for follow-up. Fracture healing was documented on radiographs and clinical outcome was evaluated with use of the Constant as well as the Kwasny score. RESULTS: Median duration until fracture consolidation was 10 weeks. In two patients fracture union was not achieved within the follow-up period. The median outcome measured with the Constant score was 93 points and 2.5 with the Kwasny score. Both values correspond to a very good functional outcome. CONCLUSION: We conclude that the flexible humeral nail is an excellent treatment option for humeral shaft fractures. Damage to the rotator cuff and the distal humerus can be avoided due to its unique flexible construction, improving the functional outcome of intramedullary nailing for the treatment of humeral shaft fractures.     

逆行置入交锁髓内钉治疗肱骨干骨折

目的　总结临床采用逆行置入交锁髓内钉治疗肱骨干骨折的经验。方法　采用 AO的专用钻头在鹰嘴窝上约 2 cm处钻孔 ,确定和准备进针入点 ,由肘向肩逆行置入 AO的非扩髓交锁髓内钉的方法治疗闭合性肱骨干骨折 15例。结果　 15例骨折在 3个月内全部骨性愈合 (8～ 12周 ) ,15例肩关节活动度于术后 3个月时已达正常对侧的 95 % ,肘关节活动度达正常的 85 %。有 2例病人肘关节活动度伸直较健侧相差 2 0°,拔钉后功能锻炼 1个月后恢复良好。结论　逆行置入交锁髓内钉治疗肱骨干骨折 ,避免了对肩袖的干扰 ,固定牢靠 ,肩肘关节功能恢复快 ,二期拆除内固定简便 ,是治疗肱骨干骨折的有效方法     

Modified extra rotator-cuff entry point in antegrade humeral nailing

Introduction We describe an extra-articular, extra-rotator cuff entry point for antegrade humeral nailing, which preserves the articular surface and rotator cuff integrity.Material and methods Thirty-two patients with humeral shaft fractures underwent antegrade intramedullary nailing using a modified insertion point located 1 cm below the crest of the greater tuberosity, in a region outside the articular surface and rotator cuff area.Results In all cases, nailing was done successfully, without any perforation of the humeral inner cortex by the nail. Extension of the fracture line to the distal metaphysis happened intraoperatively in one case of a distal diaphysis fracture. In the remainder of the patients, postoperative reduction of the fracture was successful, with no sign of an iatrogenic incident of fracture comminution. Excellent active shoulder function and full early functional recovery of the shoulder joint (to 16th week postoperatively) were established in 98% of the patients. All fractures were united in a mean period of 14 weeks.Conclusion We suggest an extra-articular, extra-rotator cuff entry point for antegrade humeral nailing as a possible and safe technique with beneficial results for the shoulders postoperative function.     

Arthroscopical Findings after Antegrade Nailing of a Proximal Humeral Fracture

Abstract Proximal humeral fractures represent up to five percent of all fractures in adults, commonly found in elderly patients. The final functional results after different operative procedures are among other factors dependent on whether or not a rotator cuff lesion is pre-existent, prior to the fracture, and how its surgical therapy is carried out. However, to what extent prior rotator cuff tears in this special patient group contribute to the functional outcome remains widely unclear. In our institution antegrade intramedullary nailing is the treatment of choice for proximal humeral fractures. One critical point of this technique is the unavoidable split of the rotator cuff on the approach to the proximal humerus and the insertion of the nail through the incised cuff. We report on a case of an impingement after antegrade intramedullary nailing of a proximal humeral fracture. Diagnostic glenohumeral arthroscopy revealed neither a residual lesion of the former rotator cuff incision nor a chondral lesion at the former insertion site of the nail. In the same session subacromial decompression and a nettoyage of adhesions were performed. We assume that splitting the rotator cuff for the insertion of an antegrade nail in a proximal humeral fracture is less relevant than previously assumed and described.     

Telegraph antegrade nailing in the treatment of humeral fractures with rotator interval split technique

Twenty-four proximal humeral fractures were treated by surgical internal fixation with a locked antegrade intramedullary nail. The purpose of this paper was to assess the clinical outcomes of proximal epiphyseal and diaphyseal humeral fractures treated with an antegrade humeral nail implanted after an interval rotator split. We treated six proximal epiphyseal fractures and seven bifocal fractures of the epiphysis and shaft and eleven diaphyseal fractures. The mean follow-up was 23 months (range 12 to 34 months). Twenty patients were available for follow-up. All but two fractures progressed to healing. The Mean Constant score was 80%, Relative Constant score was 95.5%. We divided the clinical outcomes by fracture pattern to define the best surgical indication. There were good clinical outcomes in all three groups, but the clinical score was highest in the shaft fracture group. An intramedullary antegrade nail inserted through the interval rotator without penetrating the rotator cuff had a good clinical outcome and with certain fracture types can be an effective and satisfactory device.     

Telegraph antegrade nailing in the treatment of humeral fractures with rotator interval split technique

Twenty-four proximal humeral fractures were treated by surgical internal fixation with a locked antegrade intramedullary nail. The purpose of this paper was to assess the clinical outcomes of proximal epiphyseal and diaphyseal humeral fractures treated with an antegrade humeral nail implanted after an interval rotator split. We treated six proximal epiphyseal fractures and seven bifocal fractures of the epiphysis and shaft and eleven diaphyseal fractures. The mean follow-up was 23 months (range 12 to 34 months). Twenty patients were available for follow-up. All but two fractures progressed to healing. The Mean Constant score was 80%, Relative Constant score was 95.5%. We divided the clinical outcomes by fracture pattern to define the best surgical indication. There were good clinical outcomes in all three groups, but the clinical score was highest in the shaft fracture group. An intramedullary antegrade nail inserted through the interval rotator without penetrating the rotator cuff had a good clinical outcome and with certain fracture types can be an effective and satisfactory device.     

Intramedullary nailing of humeral shaft fractures with a locking flexible nail

BACKGROUND: Studies on intramedullary nailing of humeral shaft fractures in the orthopaedic literature have shown mixed results. The purpose of this investigation was to document the clinical outcome and complications associated with the use of a new flexible, locking intramedullary nail that can be implanted in the humerus in either a retrograde or an antegrade manner without violating the rotator cuff mechanism or damaging the articular surface of the humeral head. METHODS: Fifty consecutive patients with fifty-one humeral shaft fractures were entered into our prospective clinical outcome study. The fracture was classified on the basis of the anatomic location and pattern. Implant positioning and fracture alignment were assessed postoperatively. Complications were recorded, and the time to union was measured. Shoulder function was evaluated with use of a combination of the Constant shoulder score, Short Form-36 (SF-36) clinical outcome data, range-of-motion measurements, and a subjective pain-rating scale. RESULTS: Forty-one patients with forty-two fractures had an adequate duration of clinical follow-up (a mean of twenty-two months) for analysis. Thirty-nine fractures healed, with a mean time to clinical union of twelve weeks (range, four to fifty weeks). Thirty-eight of the forty-two shoulders had minimal or no pain. Thirty-six shoulders had a full range of motion. The mean Constant shoulder score was 90 points. Four patients had five complications, which included two nonunions, two hardware failures, and one wound infection. All four patients had been managed with a 7.5-mm nail. A multivariate analysis demonstrated that an age of more than fifty years was associated with a lower Constant score and that the occurrence of a complication was associated with a lower physical component score on the SF-36. CONCLUSIONS: The flexible humeral nail allows both retrograde and antegrade implantation and static locking. Nail insertion can be accomplished without violating the rotator cuff or damaging the articular surface of the humeral head. Although the nail functioned well in most of our patients, the use of a small-diameter (7.5-mm) nail was associated with a higher complication rate. This implant should be used with caution in any patient with a medullary canal diameter of 相似文献   

Clinical performance of a new medullary humeral nail: antegrade versus retrograde insertion.

OBJECTIVE: A new intramedullary nail system for humeral shaft fractures is evaluated to determine whether retrograde nailing is as reliable as antegrade nailing. STUDY DESIGN: Prospective multicenter nonrandomized clinical study. PATIENTS: Eighty-four patients with acute humeral shaft fractures were nailed with the new unreamed humeral nail (UHN) system. Fifty-seven nails were introduced retrogradely, and twenty-seven antegradely. Bone healing and functional outcome were the follow-up parameters. RESULTS: The ratio of perioperative complications was equivalent for both groups, but one shaft fracture and three fractures or fissures at the entry point occurred in the group with retrograde nail insertion. Five fractures, all with retrograde nail insertion, needed secondary surgery to achieve bony healing. There was no difference in functional outcome after healing in either group. CONCLUSION: Retrograde nailing of humeral shaft fractures is technically more demanding than antegrade nailing. Fractures or fissures at the insertion point must be avoided by adequate preparation of the entry hole and careful nail insertion. Bone healing problems seem more surgeon-related than approach-related. As in every other procedure, an optimal fracture configuration and high fracture stability must be achieved.     

Humeral nailing revisited

Unreamed interlocked humeral nailing for stabilisation of acute humeral fractures was introduced a decade ago. Antegrade and retrograde nail insertion are equally popular. The role of nailing as opposed to plating of humeral fractures is the subject of continuous debate. Between 1997 and 2005, 99 acute fractures of the humeral shaft were treated operatively with the unreamed humeral nail (UHN, Synthes) in our Level I Trauma Centre. The mean age of the patients was 63 years. Only eight patients (8.1%) were polytraumatised, nine patients had an open fracture (9.1%), five had a primary radial nerve palsy (5.1%). There were 54 antegrade and 45 retrograde nailings. The procedures were performed by 19 different surgeons, who carefully followed a detailed operation protocol. There were 6 adverse events: 3 secondary radial nerve palsies (3%), 2 fissures at the insertion point (2%) and one false placement of a locking screw (1%). Three patients developed pseudarthrosis (3%). Eight further operation were necessary (8.1%): 3 exploration of the radial nerve, 3 for treatment of pseudarthrosis, one replacement of a locking screw and one wound revision for superficial wound infection. Ninety patients (92 fractures) were evaluated after bone healing. Shoulder function was assessed using the Constant Score, elbow function with the Mayo Elbow Score. 91.3% and 5.4% of patients had an excellent or good shoulder function, 81.5% and 14.1% had an excellent or good elbow function. All patients with a functional deficit of the shoulder joint had antegrade, all patients with a deficit at the elbow joint retrograde nailing. Motor function recovered in all radial nerve palsies. 93.5% of patients had an excellent or good functional end result.Unreamed humeral nailing is a valid therapeutic option for stabilisation of acute humeral shaft fractures. Antegrade and retrograde nailing are associated with specific but different complications. By strictly adhering to the operation technique, the number and severity of complications can be reduced. When good fracture alignment and stability are obtained, uneventful bone healing with good functional outcome is the rule.