交锁髓内针治疗股骨髁上及髁间粉碎骨折35例

对交锁髓内钉治疗股骨髁上、髁间骨折的指征、方法、疗效及应用中的注意问题进行研究。随访本院１１年间用交锁髓内钉固定股骨髁上及髁间骨折的病人，对病人的一般情况、术后并发症及功能恢复等作了分析。３５例股骨远端髁上或髁间骨折中３１例得到随访（平均２７个月），骨折均愈合。采用改良膝关节功能评分，１２例（３８．７％）优，１５例（４８．４％）良，４例（１２．９％）可，优良率为８７．１％。认为股骨远端或髁间粉碎骨     

逆行交锁髓内钉与股骨远端锁定钢板内固定治疗股骨髁上骨折的疗效比较

目的比较逆行交锁髓内钉与股骨远端锁定钢板内固定治疗股骨髁上骨折的疗效。方法 168例股骨髁上骨折采用逆行交锁髓内钉固定治疗62例(髓内钉组),股骨远端锁定钢板内固定治疗106例(钢板组),对两组临床资料和术后功能恢复情况进行比较。结果 168例获平均随访24.6个月,骨折均愈合。钢板组与髓内钉组比较,平均切口较长,术中出血量较多,但手术时间较短,差异有统计学意义(P<0.05);两组Bristol评分优良率比较差异无统计学意义(P>0.05)。结论逆行交锁髓内钉与股骨远端锁定钢板内固定治疗股骨髁上骨折临床疗效均满意,但交锁髓内钉固定手术切口小、出血量少。     

逆行交锁髓内钉治疗股骨髁上及髁间骨折

目的对应用股骨髁上逆行交锁髓内钉(GSH)治疗股骨髁上及髁间骨折的临床经验进行总结。方法应用股骨髁上逆行交锁髓内钉治疗股骨髁上及髁间骨折15例，采用AO分类法：A型12例，C型3例。均采用切开复位内固定。结果随访时间为6～24个月，所有骨折均获骨性愈合，平均愈合时间6个月。按Kolmert功能评分标准．优8例，良5例，可2例，优良率为86．7％。结论采用股骨髁上逆行交锁髓内钉是治疗股骨髁上及髁间骨折的有效方法。     

逆行交锁髓内钉治疗股骨髁间骨折

目的　介绍髁上逆行交锁髓内钉治疗股骨髁间骨折的方法。方法　应用股骨髁上逆行交锁髓内钉治疗股骨髁间骨折 10例 ,其中“T”或“Y”型骨折 5例 ,粉碎型骨折 5例 ,全部病例进行临床随访评定效果。结果　 10例经 6～ 2 4个月 (平均 12个月 )随访 ,无近晚期并发症 ,骨愈合良好 ,平均愈合时间 4个月 ,术后功能恢复总体优良率达 90 %。结论　股骨髁上逆行交锁髓内钉具有操作简便、固定牢靠、锁定准确等优点 ,有较好的临床应用价值     

逆行交锁髓内钉治疗股骨髁间骨折

目的介绍髁上逆行交锁髓内钉治疗股骨髁间骨折的方法。方法应用股骨髁上逆行交锁髓内钉治疗股骨髁间骨折１０例,其中“Ｔ”或“Ｙ”型骨折５例,粉碎型骨折５例,全部病例进行临床随访评定效果。结果１０例经６－２４个月）平均１２个月）随访,无近晚期并发症,骨愈合良好,平均愈合时间４个月,术后功能恢复总体优良率达９０％,结论股骨髁上逆行交锁髓内钉具有操作简便,固定牢靠,锁定准确等优点,有较好的临床应用价值。     

股骨髁上逆行交锁髓内钉治疗股骨远端骨折

目的：分析使用股骨髁上逆行交锁髓内钉治疗股骨远端骨折的方法和临床疗效。方法：应用股骨髁上逆行交锁髓内钉治疗股骨远端骨折18例，均采用开放复位内固定。结果：随访时间11－28个月，骨折全部愈合，按Kolmert功能评分标准，优9例，良7例，可2例，优良率为88．9％。结论：股骨髁上逆行交锁髓内钉具有操作简便，固定牢固，骨愈合率高，便于膝关节早期活动的优点，是治疗股骨远端骨折的有效方法。     

逆行带锁髓内钉治疗股骨髁上及髁间骨折疗效分析

目的：探讨GSH逆行带锁髓内钉治疗股骨髁上及髁间骨折的疗效。方法：从1998年1月～2002年12月，我院采用逆行带锁髓内钉治疗股骨髁上骨折及髁间骨折20例，其中股骨髁上骨折14例，髁上伴髁间骨折6例。男性15例，女性5例，年龄20～75岁，平均年龄35岁。术后早期CPM肢体功能锻炼，平均随访12～18月。结果：所有骨折均获得骨性愈合，平均愈合时间6个月。根据Kolment膝关节功能评分标准，优12例，良4例，可3例，差1例，优良率80％。结论：逆行带锁髓内钉治疗股骨髁上骨折及髁间骨折具有内固定坚强、操作简便、创伤小等优点，术后配合CPM早期功能锻炼，可以获得满意疗效。     

股骨髁上交锁髓内钉治疗股骨远端粉碎骨折

目的：评价股骨髁上交锁髓内钉治疗股骨远端粉碎骨折的效果。方法：应用股骨髁上交锁髓内钉治疗股骨远端骨折37例,闭合及小切口开放复位,做膝关节小切口,从股骨髁间窝处插入交锁髓内钉治疗股骨髁上皮髁间粉碎骨折,结果：37例切口顺利愈合,无关节感染发生,骨折复位好,35例骨愈合平均12．4周,膝关节屈曲平均105度,结论：股骨髁上交锁髓内钉手术操作简单,固定可靠,对软组织破坏少,骨愈合率明显,骼于治疗股骨远端复杂骨折手术效果好。     

股骨髁上交锁髓内钉治疗股骨远端骨折

交锁髓内钉技术已普遍应用于四肢长骨干骨折的治疗。对股骨远端髁上、髁间骨折，目前国内多采用钢板螺钉内固定。我院自2000年1月～2004年3月，应用股骨髁上交锁髓内钉(IMSC)治疗36例股骨远端骨折，取得良好效果。本文对该技术的适应证，使用方法，应用特点和临床使用的有关问题作一介绍。     

GSH钉治疗股骨远端骨折（附57例报告）

目的 总结临床采用GSH钉(股骨髁上逆行交锁髓内钉)技术治疗股骨远端骨折的经验。方法 应用GSH钉及术后不用外固定，早期麻醉镇痛下膝关节CPM功能锻炼治疗57例股骨远端骨折。结果 X线片显示41例骨折达到解剖或接近解剖复位，膝关节功能评分优25例，良19例，可11例，差2例，优良率为77．2％。结论 GSH钉具有操作简便、固定可靠、手术创伤小等优点，与膝关节CPM功能锻炼相结合治疗股骨远端骨折疗效确切。     

逆行交锁髓内钉治疗股骨远端骨折

目的探讨逆行交锁髓内钉治疗股骨远端骨折的临床疗效。方法采用逆行交锁髓内钉治疗股骨远端骨折37例。结果 37例均获随访,时间6～20个月。骨折均愈合。膝关节功能评分按Duwelius et al标准评定:优25例,良10例,可1例,差1例,优良率为94.6%。结论逆行交锁髓内钉治疗股骨远端骨折,适应证广、膝关节功能恢复快、临床疗效好。     

逆行交锁髓内钉治疗股骨远端骨折

目的 探讨逆行交锁髓内钉在治疗股骨远端骨折中的应用价值。方法 采用逆行交锁髓内钉对22例AO分型为A、C型新鲜股骨远端骨折病例行内固定。结果 所有病例均获随访，21例获牢固骨性愈合，未见畸形愈合、感染。1例发生主钉尾端处骨折，1例发生近端锁钉断裂。术后根据KSS评分体系，评价优14例，良6例，一般2例，优良率90．9％。结论 逆行交锁髓内钉适用于股骨远端骨折，具有高度的稳定性，操作简单，出血少，并发症少，功能恢复快。     

Stable osteosynthesis by interlocking cylinder nailing for fractures of the femur and tibia

Between 1979 and 1986, 140 patients with fractures of the femur and 94 with tibial fractures were treated with our own interlocking cylinder nail system and followed for 1 to 3 years. Overall, 97.9% of fractures of the femur and 93.6% of the tibia were found to have achieved excellent or good results clinically and radiologically. Complications included: delayed union which developed in 2 patients with femoral and tibial fractures and deep infection which developed in 3 of the tibial fractures. Even in highly comminuted fractures, the fracture site can be fixed securely with the interlocking cylinder nail system. Because mechanical strength of the cylinder nail is by far superior to that of the clover nail, the patient may be allowed early full weight bearing on his affected leg.     

交锁髓内钉治疗股胫骨骨折110例分析

目的　探讨交锁髓内钉治疗股、胫骨骨折的疗效 ,分析并发症发生原因 ,提出防治措施。方法　 110例股、胫骨骨折 (闭合骨折 83例 ,开放骨折 2 7例 ) ,除 2例股骨和 5例胫骨闭合复位未扩髓外 ,余均采用开放复位并有限扩髓 ,应用交锁髓内钉固定。随访 3～ 2 4个月 ,平均随访 14个月。结果　 110例骨折全部愈合 ,其中髓内钉折断 5例 ,锁钉折断或松动退出 4例 ,骨折成角畸形 4例 ,骨折延期愈合 8例 (股骨 3例 ,胫骨 5例 ) ,无感染病例。按Johner -Wruh法功能评定 :优 83例 ,良 2 3例 ,中 3例 ,差 1例。结论　只要掌握好手术指征及正确处理所遇问题 ,交锁髓内钉治疗股、胫骨骨折是一种较好的内固定方式     

Distal unlocked proximal femoral intramedullary nailing for intertrochanteric femur fractures

We investigated whether a proximal femoral nail (PFN) having two lag screws can be implanted without distal locking screws in AO/OTA 31-A1 and 31-A2 intertrochanteric femur fractures. Twenty-four patients with AO/OTA 31-A1 and 31-A2 fractures were treated with a PFN without distal interlocking by a single surgeon. The mean follow-up was 12 months (range: 7–23). Clinical and functional outcome was assessed according to the Harris hip score and Barthel’s activity score. The fractures healed in all patients; the average consolidation time was 14 weeks (range: 9–28). Fourteen patients had excellent and good results, nine patients had fair results, and one patient had a poor result according to the Harris hip score; 17 patients had a high range of mobility according to the Barthel activity score. Our results suggested that the PFN can be successfully implanted without distal interlocking in 31-A1 and 31-A2 fractures.     

Interlocking nailing of distal femoral fractures: 28 patients followed for 1-2 years

We treated 28 fractures of the distal femur with a Grosse-Kempf interlocking nail, and the patients were followed for at least 1 year. Five fractures did not unite, and the rest healed after 5 (3-7) months. Nail breakage was the most serious complication; and the more distal the fracture was, the more easily the nail broke. With the addition of a cast brace and protected weight bearing, a locked nail is a good type of fixation for distal femoral fractures down to 4 cm above the condyles.     

Interlocking nailing of distal femoral fractures. 28 patients followed for 1-2 years

We treated 28 fractures of the distal femur with a Grosse-Kempf interlocking nail, and the patients were followed for at least 1 year. Five fractures did not unite, and the rest healed after 5 (3-7) months. Nail breakage was the most serious complication; and the more distal the fracture was, the more easily the nail broke. With the addition of a cast brace and protected weight bearing, a locked nail is a good type of fixation for distal femoral fractures down to 4 cm above the condyles.     

股骨远近段骨折髓内钉置入失误分析及对策

目的根据股骨远近段的解剖特点,分析股骨交锁髓内钉置入操作失误的原因及处理对策,以提高交锁髓内钉置入的成功率。方法自2002年1月～2006年3月,笔者观察210例股骨远近段骨折交锁髓内钉的置入过程,并对股骨远近端松质骨髓腔高度进行测量。结果132例操作顺利,78例出现交锁髓内钉置入失误,采用自制髓腔轴线控制棒校正开口处骨道轴线,取得满意效果。结论开口处骨道轴线与髓腔轴线同轴是交锁髓内钉置入的关键,出现失误时不能使用暴力,需校正开口轴线,重新置入髓内钉。     

Retrograde intramedullary nailing of supracondylar femur fractures above total knee arthroplasty: A preliminary report of four cases

Four supracondylar fractures of the femur in three patients with total knee arthroplasties were treated by retrograde intramedullary nailing using an interlocking reamed nail (GSH Nail, Smith and Nephew Richards, Memphis, TN) specifically designed for fractures of the distal femur. Three cases were acute fractures and one was a refracture through a screw hole of a previously plated supracondylar fracture. All fractures healed and there were no complications. The procedure is performed by closed nailing using fluoroscopic guidance with the nail placed through the intercondylar notch of the femoral prosthesis and interlocking to the fracture fragments with a percutaneous targeting device. The advantages are that the procedure is performed by closed techniques that preserve the fracture hematoma and reduce operative blood loss, the fracture is stabilized by a load-sharing nail, and immediate motion with limited weight bearing is possible.     

Interlocking nailing of distal femoral fractures. Technique and results

Treatment with interlocking nails is sufficient for fractures at the distal diaphysis and the distal methaphyseal region of the femur. Fractures associated with intracondylar fissures can be treated with an interlocking nail only in isolated cases. This paper gives a report on 47 cases and compares two series. The complications observed were: infection (4.25%); fracture of nail (4.25%); and deviation of axis (12.08%). We didn't observe pseudarthrosis in any of these patients. Bone healing occurred in all cases.