联合应用分叉状髓内钉和环抱片治疗肱骨干骺端骨折

目的 探讨交锁髓内钉在肱骨干骺端骨折中的应用，扩大交锁髓内钉的适应证。方法 回顾性分析1999年5月～2003年3月行肱骨干骺端骨折交锁髓内钉固定术的患者12例。12例肱骨骨折中，骨折线位于外科颈以上5例，距肱骨下端关节面3～4cm以内7例，其中累及肩关节2例。根据临床疗效综合评定该手术方式的可能性。结果 术后无1例发生伤口感染、骨不连、关节功能障碍等并发症。随访10～36个月，平均25个月，肱骨远近端骨折平均愈合时间分别为10周、11周，所有骨折均愈合，术后6个月正常持物。评价按Rodriquez—Merchan标准：优良11例，1例畸形愈合，优良率为91．6％。结论 在肱骨干骺端骨折中使用交锁髓内钉疗效满意，扩大了交锁髓内钉的适应证。     

联合应用分叉状髓内钉和环抱片治疗肱骨干骺端骨折

目的　探讨交锁髓内钉在肱骨干骺端骨折中的应用 ,扩大交锁髓内钉的适应证。方法　回顾性分析 1999年 5月～ 2 0 0 3年 3月行肱骨干骺端骨折交锁髓内钉固定术的患者 12例。 12例肱骨骨折中 ,骨折线位于外科颈以上 5例 ,距肱骨下端关节面3～ 4cm以内 7例 ,其中累及肩关节 2例。根据临床疗效综合评定该手术方式的可能性。结果　术后无 1例发生伤口感染、骨不连、关节功能障碍等并发症。随访 10～ 36个月 ,平均 2 5个月 ,肱骨远近端骨折平均愈合时间分别为 10周、 11周 ,所有骨折均愈合 ,术后 6个月正常持物。评价按Rodriquez-Merchan标准 :优良 11例 ,1例畸形愈合 ,优良率为 91 6 %。结论　在肱骨干骺端骨折中使用交锁髓内钉疗效满意 ,扩大了交锁髓内钉的适应证。     

AO非扩髓肱骨交锁髓内钉在肱骨干骨折不愈合中的应用

目的 探讨AO非扩髓(AO—UHN)肱骨交锁髓内钉加自体松质骨植骨在肱骨干骨折不愈合中的应用。方法 20例患者手术取出原内固定，行正向或逆向插入AO—UHN肱骨交锁髓内钉，在不愈合部位行丰富的自体松质骨植骨。术后进行影像学观察和疗效评定。结果 20例患者有15例得到随访，随访时间为9～23个月(平均13．8个月)，愈合时间4～10个月(平均6．2个月)。除1例在12个月时仍未愈合予再次植骨后6个月获得愈合外，其余均在一次手术后获得愈合，优良率为90％。结论 AO—UHN肱骨交锁髓内钉加自体松质骨植骨是治疗肱骨干骨折不愈合的一种有效方法。     

逆行交锁髓内钉治疗肱骨干骨折

目的报告应用逆行交锁髓内钉治疗肱骨干骨折的疗效。方法采用肱骨交锁髓内钉逆行进钉内同定治疗肱骨干骨折16例，钢板内固定治疗肱骨干骨折17例分别从手术情况、并发症、生物力学、骨折愈合情况、功能恢复等方面进行比较与分析结果所有患随访5～18个月．平均7．6个月，髓内钉逆行内固定组：平均骨折愈合时间6．3个月．术后尺神经麻痹1例，无一例髓内钉和锁钉折弯或断裂，功能煅练时间早．骨折愈合牢固，功能恢复良好：钢板内固定：平均骨折愈合时间5．6个月，术后桡神经麻痹2例，螺钉松动、折断和钢板弯曲各1例，骨不连1例，骨延迟愈合3例．结论肱骨干骨折逆行交锁髓内钉内固定术，方法简单安全．内固定牢靠，术后并发症少．疗效优于钢板内固定术。     

带锁髓内钉内固定加经皮注射红骨髓治疗肱骨骨不连

目的 探讨采用Ｒｕｓｓｅｌｌ－Ｔａｙｌｏｒ扩髓型带锁髓内钉顺得内固定与植骨、术后注射红骨髓治疗肱骨骨不连。方法 肱骨骨不连患者２５例,以往平均手术次数２次,骨折后时间１０个月～４年,平均１年１０个月。用带锁髓内钉顺行静力型固定骨折端,取自体髂骨植骨缺损。术后１０ｄ于骨折区注射自体红骨髓。术后早期功能锻炼。平均随访时间１６个月。结果 所有病例均达到骨性愈合,平均愈合时间４．５个月,关节功能恢复很好。     

附加锁定接骨板结合自体髂骨植骨治疗股骨干骨折交锁髓内钉固定术后骨不连

目的探讨附加锁定接骨板结合自体髂骨植骨治疗股骨干骨折交锁髓内钉固定术后骨不连的临床疗效。方法对10例股骨干骨折交锁髓内钉固定术后骨不连采用附加锁定接骨板结合自体髂骨植骨治疗。结果10例术后均获得平均12（8-18）个月随访。骨折均获愈合,愈合时间平均5．2（4～6）个月,膝关节屈伸功能恢复良好。结论附加锁定接骨板结合自体髂骨植骨治疗股骨干骨折交锁髓内钉固定术后骨不连创伤小、操作简单、骨折愈合快、功能恢复好,是一种理想的治疗方法,临床上值得推广。     

自锁髓内钉逆行固定治疗肱骨骨折及骨不连

目的观察自锁髓内钉逆行固定治疗肱骨骨折及骨不连的疗效。方法1999年3月～2007年3月采用自锁髓内钉逆行固定治疗肱骨骨折及骨不连21例，根据术后x线片观察骨折愈合情况及肩肘关节功能综合判定疗效。结果经术后6个月-3年（平均14个月）的随访，优16例，良5例，差0例。所有骨折及骨不连均达到骨性愈合，平均骨愈合时间为4．5个月，未发生医源性桡神经损伤。结论自锁髓内钉逆行固定治疗肱骨骨折及骨不连具有骨折愈合率高，可降低桡神经损伤的危险，对肩肘关节功能影响小、手术操作简单可靠等优点，对肱骨骨折及骨不连是比较理想的治疗方法之一。     

扩髓更换交锁髓内钉治疗股骨干术后肥大型骨不连

目的 分析扩髓后更换交锁髓内钉治疗股骨干术后肥大型骨不连的效果.方法 对于35例肥大型股骨干骨不连患者行扩髓后更换交锁髓内钉治疗,术中无需植骨,不暴露骨折断端,术后不行外固定,早期活动关节.结果 术后随访7～24个月,平均13个月.35例术后均无伤口感染,主钉及锁钉均无断裂或折弯.骨折均愈合,愈合时间14～30周(平均20周),未出现明显手术并发症.结论 扩髓后更换交锁髓内钉治疗股骨干术后骨不连操作简便,效果确切.     

髓内钉固定结合自体髂骨植骨治疗肱骨干骨不连

目的 探讨髓内钉固定结合自体髂骨植骨治疗肱骨干骨不连的疗效。方法 1999年6月至2008年5月共收治27例肱骨干骨不连患者,男14例,女13例;年龄24～65岁,平均35.5岁;左侧11例,右侧16例;骨不连部位：中上段6例,中段16例,中下段5例。骨不连类型：肥大型22例,萎缩型5例。所有患者均1～4次手术史,平均2.3次。16例采用肱骨交锁髓内钉固定,其中1例闭合穿髓内钉,5例采用更换原髓内钉后外加钢缆张力带固定;11例采用肱骨膨胀髓内钉。除1例闭合复立固定的患者外,其余26例患者均行自体髂骨植骨。结果 26例患者术后获1年3个月至8年6个月（平均4年2个月）随访,骨不连均获骨性愈合,愈合时间为4～8个月（平均5.4个月）。肩关节功能按Neer评分标准评定：优12例,良8例,可6例,优良率为76.9％。肘关节功能按Mayo评分标准评定：优23例,良3例,优良率为100％。1例桡神经损伤患者术后6个月恢复伸腕、伸拇及伸指功能。结论 肱骨髓内钉固定结合自体髂骨植骨治疗肱骨干骨不连具有骨愈合率高、对肩肘关节影响小等优点。     

加压交锁髓内钉固定加植骨治疗胫骨骨不连的临床研究

目的:探讨加压交锁髓内钉内固定加交锁髓内钉开口处取骨植骨治疗胫骨骨不连的临床疗效。方法:回顾性分析自2008年2月至2010年10月采用加压交锁髓内定内固定加髓内针开口处取骨植骨治疗18例胫骨骨干骨不连,男12例,女6例;年龄31～67岁,平均42岁。受伤至手术时间6～18个月,平均8个月。骨折不愈合11例,延迟愈合7例。术后根据HSS评分系统评价膝功能,采用Tenny和Wiss评分系统评估疗效。结果:术后随访12～36个月,平均18个月,患者切口愈合良好,无感染,无皮肤坏死。全部患者未见骨不愈合、感染、畸形及再骨折发生。骨性愈合时间4～8个月,平均6个月。患者术后1年膝关节功能HSS评分平均(89.97±3.21)分。术后根据Tenny和Wiss评分系统评估疗效,优16例,良2例。结论:采用加压交锁髓内钉内固定加交锁髓内钉开口处取骨植骨治疗胫骨骨折不愈合及延迟愈合,能提高骨折愈合率,避免髂骨取骨带来的并发症,减少患者医疗费用。     

Treatment of nonunions of humeral fractures with inter-locking intramedullary nailing

Objective： To introduce the experience of treating nonunions of humeral fractures with interlocking intramedullary nailing.
Methods： Twelve patients with humeral nonunions were treated with interlocking intramedullary nailing. The time interval between trauma and surgery was 10.5 months on average. Open reduction with anterograde approach was performed. Axial compression was specially applied to the fracture site with humeral nail holder after insertion of distal locked screws. Iliac bone grafting was added.
Results： The average follow-up period was 21 months （ranging 9-51 months）. All patients achieved osseous union 5.8 months after treatment on average. Eleven patients hadgood functions of the shoulder joints and the upper extremities. No patient experienced any permanent neurological deficit. Refracture of the original ununited region occurred in one patient after removal of the internal fixator one year later, but union was achieved after closed re-intramedullary nailing fixation.
Conclusion： Humeral interlocking intramedullary nailing is an effective alternative treatment for humeral nonunion.     

Treatment for nonunion of the shaft of the humerus: comparison of plates and Seidel interlocking nails.

From July 1986 to November 1989, fractures of the humeral shaft in 35 adults who had nonunion of the fracture were managed by plate fixation (19 patients) or antegrade nailing of the fracture fragments with the Seidel interlocking nail (16 patients) together with cancellous bone grafting. The follow-up period ranged from 12 to 52 months. Of the patients who had plate fixation, 89.5% had fracture union within 4.5 +/- 1.7 months; of the patients whose fracture was managed with the Seidel interlocking nail, 87.5% had fracture union within 4.4 +/- 1.8 months. The range of shoulder motion was improved with both techniques. Patients who had plate fixation had more complications than those whose fracture was managed by interlocking nailing (21% v. 12%). The authors prefer interlocking nailing because it is a relatively simpler technique, resulting in fewer complications. It may replace plating in the treatment of nonunion of humeral shaft fractures. However, rotatory instability with interlocking nailing cannot be disregarded, and if this is evident plate fixation should be done.     

Interlocking intramedullary nailing for nonunion of the proximal humerus with the Straight Nail System

Nonunion of the proximal humerus is a challenging problem. Since 1996, we have performed interlocking intramedullary nailing for the treatment of proximal humeral nonunions with the Straight Nail System and bone grafting. The objective of this study was to investigate the clinical outcomes of this procedure in patients with proximal humeral nonunion. We investigated 14 consecutive patients (mean age, 74.3 +/- 8.7 years). One patient was excluded because of associated brachial plexus palsy. All but 2 were initially treated conservatively. Range-of-motion exercises were started 1 week after the operation. The mean follow-up period was 37.8 months. Union was achieved in all cases without any evidence of malunion. All patients had improved range of motion of the shoulder and were satisfied with the surgical results. Mean flexion of the shoulder was 122 degrees +/- 14 degrees, and mean external rotation was 35 degrees +/- 10 degrees. Interlocking intramedullary nailing with the Straight Nail System and bone grafting offered a successful method of stable internal fixation in these complex proximal humeral nonunion cases.     

椎间盘镜下微创植骨治疗下肢骨折术后骨不连

目的探讨在椎间盘镜下微创植骨治疗股骨、胫骨骨折术后骨不连的疗效。方法 2004年8月-2008年8月,采用椎间盘镜下植骨治疗股骨、胫骨骨折术后骨不连患者40例。男23例,女17例;年龄20～63岁,平均41.5岁。骨折后初次手术采用股骨带锁髓内钉固定治疗12例,钢板固定16例;胫骨带锁髓内钉固定9例,钢板固定3例。内固定术后10～16个月发生骨不连。X线片示肥大型骨不连24例,正常型3例,萎缩型13例。结果患者手术时间40～80 min,平均61min;出血量80～130 mL,平均100 mL。住院时间6～11 d,平均8.1 d。患者切口均Ⅰ期愈合,无感染及血管、神经损伤等并发症发生。40例均获随访,随访时间10～16个月,平均12.3个月。X线片示40例骨折均愈合,愈合时间4～10个月,平均6.8个月。无患肢疼痛及功能障碍,无内固定失效。结论经椎间盘镜下微创植骨治疗股骨、胫骨骨折内固定术后骨不连是一种微创、有效的治疗方法。     

Treatment of humeral shaft delayed unions and nonunions with humeral locked nails

OBJECTIVE: To report experience with use of humeral locked nails in treating humeral delayed unions and nonunions. The following techniques yielded encouragingly good results: static locking, short-to-long segment nailing, bone grafting, fracture compression, and minimal surgical trauma. DESIGN AND METHODS: A total of 41 consecutive patients with 13 delayed unions and 28 nonunions were treated with humeral locked nails. Delay from trauma to surgery averaged 4.2 months for delayed union and 15.5 months for nonunion. The average age of patients was 50.2 years; average follow-up time was 23.2 months. There were 7 proximal-third fractures, 21 middle-third fractures, and 13 distal-third fractures. The antegrade approach was used for 13 fractures and retrograde for 28. Open nailing was performed in 39 fractures and closed nailing in 2. If the fracture motion was still present after nail insertion, axial compression of the fracture site was specially applied. Bone grafting was performed in the fractures with open nailing. Thirty-four fractures were nailed with 8-mm nails, and 7 fractures were nailed with 7-mm nails. RESULTS: With a single operation, all but two patients achieved osseous union in, on average, 5.6 months. One of these two patients eventually gained union after another surgery with fracture compression along the original nail and concurrent bone grafting. The second patient, undergoing hemodialysis for chronic renal failure, had persistent nonunion. At follow-up, for patients with antegrade nailing, all but four patients had less than 20 degrees limitation of shoulder abduction. For patients with retrograde nailing, all but two had less than 10 degrees limitation of elbow motion. Only the patient with persistent nonunion had continual pain and significant impairment of arm function. CONCLUSIONS: Humeral locked nailing seems to be effective for humeral delayed unions or nonunions. It may be an acceptable alternative for fractures unsuited for plate fixation, such as those with comminution, osteoporosis, or a severely adhered radial nerve.     

Treatment of humeral shaft nonunion with interlocking nail and percutaneous injection of bone marrow

OBJECTIVE: To investigate the effect of treatment of humeral shaft nonunion with interlocking nail and percutaneous injection of bone marrow after operation. METHODS: Twenty-five adult patients with humeral shaft nonunion, initially treated with plates, intramedullary nails, or external fixators changed to use RussellTaylor reamed antegrade intramedullary nails with autologous bone grafting and percutaneously bone marrow injection into the fracture sites ten days after the operation to promote union. RESULTS: All patients achieved a solid union with good function. The union period was a median of 4.5 months. CONCLUSION: We believe that the procedure may provide firm internal fixation and improve activity of osteoblasts in fracture sites for accelerating fracture healing.     

带蒂骨痂植骨交锁髓内钉内固定治疗胫骨硬化型骨不连

[目的]观察交锁髓内钉内固定、带蒂骨痂和自体髂骨植骨术治疗胫骨硬化型骨不连的临床疗效.[方法]本组胫骨硬化型骨不连12例,男8例,女4例;年龄26～64岁,平均45岁,全部采用开放置入交锁髓内钉内固定、带蒂骨痂和自体髂骨植骨术治疗.[结果]经12～72个月,平均48个月的随访,所有病例均于4～6个月内获得骨性愈合.[结论]交锁髓内钉内固定、带蒂骨痂和自体髂骨植骨术治疗胫骨硬化型骨不连具有：（1）合理的生物力学设计;（2）抗骨折旋转及短缩功能;（3）对局部血运破坏小;（4）带蒂骨痂植骨的＂架桥＂作用和自体髂骨植骨的成骨作用促进骨愈合,值得推荐使用.     

Treatment of aseptic nonunion after intramedullary nailing fixation with locking plate

Objective: To evaluate the safety and efficacy of locking plate combined with bone grafting in the treatment of aseptic nonunion following intramedullary nailing fixation of fractures of the long bones. Methods: Thirty‐eight consecutive patients treated in our hospital between January 2004 and December 2006 were included in this retrospective study. The nonunions included 20 femurs, 15 tibias, and 3 humeri. The duration of non‐union ranged from 6 to 84 months and 21 (55.3%) of them were located around the metaphysis of the affected long bones. There were 12 women and 26 men with a mean age of 39.2 years (range, 9–70 years). Locking plate combined with bone grafting was the procedure chosen to treat every case of nonunion in this series. The clinical outcomes were evaluated. Results: All patients were followed up for 6–20 months (average 11.6 months). After locking plate fixation combined with bone grafting, union was achieved in all cases, the average healing time being 5.3 months (range, 4–8 months). Infection of the superficial incision occurred in three cases (7.9%) and delayed healing of the incision in one case, all of which healed with no further complications. The function of the adjacent joints was excellent to good in 30 patients (78.9%), fair in 7 (18.4%) and poor in 1 (2.6%) after follow‐up. Conclusion: Locking plate fixation combined with bone grafting is a highly effective treatment for aseptic nonunions of the long bones after intramedullary nailing fixation, especially in the case of metaphyseal nonunion.     

Open exchange locked nailing in humeral nonunions after intramedullary nailing

Humeral nonunions after cannulated intramedullary nailing have been difficult to reconstruct. In the current study, 23 consecutive patients were treated by open exchange locked nailing with bone grafting. There were 16 men and seven women with a mean age of 46.2 years. The nonunions followed humeral locked nailing in eight patients, Seidel nailing in 13, and Küntscher nailing in two. The average nonunion time was 14.7 months. The nonunions, located at the proximal (1/3) in four humeri, middle (1/3) in 15, and distal (1/3) in four, were antegrade nailed in 10 and retrograde nailed in 13. Nineteen had 8-mm nails and four had 7-mm nails. Supplementary wiring was used in 19 patients. The average followup was 21.4 months. With one surgery, all but one patient (96%) achieved osseous union in, on average, 16.3 weeks. One patient with chronic renal dialysis had persistent nonunion and an osteolytic supracondylar fracture. Other complications included one postoperative radial nerve palsy, one brachial artery injury, and one wire infection. At followup, all patients with solid union had excellent or satisfactory recovery of shoulder function. The average postoperative Neer score (90.7) was significantly better than the average preoperative score (68.5). Two patients had losses of elbow motion of 10 degrees and 20 degrees, respectively. This study shows that humeral nonunion after cannulated intramedullary nailing can be treated effectively by open exchange locked nailing with bone grafting. Supplementary wiring can compress the nonunion and facilitate bone healing.