自动加压防旋髓内钉的研制及修复股骨中下段骨折的应用

目的 研制一种自动加压防旋髓内钉，探讨其生物力学和在修复股骨中下段骨折的应用效果。方法 采用研制的自动加压防旋髓内钉于1998年1月～2001年6月，临床用于修复股骨中下段骨折23例，其中横、短斜形骨折12例，粉碎骨折9例，斜形、多段骨折各1例，手术时间为伤后2小时～8天。陈旧性骨折2例，手术时间为伤后11～13个月。在梅花型圈内钉距近远端一定距离的两侧翼开孔，置入梅花型弹力环2～4枚以适应股骨髓腔宽大部。手术时间30～75分钟，平均43分钟。结果 在5Nm扭矩下，自动加压防旋髓内钉的抗旋转作用与交锁钉相近；23例骨折均愈合，其中21例为6～13周，平均9周，2例陈旧性骨折为15～22周。术后均获随访6～36个月。无感染、畸形愈合、骨不连、关节僵硬及再骨折等并发症。按Kolmert等功能评定标准，优19例，良3例，可1例，优良率95．7％。结论 自动加压防旋髓内钉设计合理，生物力学性能稳定，临床应用操作简便，手术时间短，骨折愈合快，具有铀向加压及防旋功能。

STUDY AND CLINICAL APPLICATION OF AUTO-COMPRESSIVE AND ANTI-CIRCUMROTATE INTRAMEDULLARY NAIL

Objective To design an auto-compressive and anti-circumrotate intramedullary nail( ACACIN) and to evaluate the preliminary clinical efficacy on fixing adult femur fracture. Methods From January 1998 to June 2001, 23 patients with femur fracture were stabilized with auto-compressive and anti-circumrotate intramedullary nail. 2-4 elastic blocks were installed into the proximal and distal different distance of quincunx nail to defend circumrotate and axis compress. Results Fracture healing were obtained in all 23 patients treated with auto-compresseive and anti-circumrotate intramedullary nail, the time of fracture healing was 6 - 13 weeks in 21 cases and 15-22 weeks in 2 cases of old fracture. There was no complication related to infection, nail break, abnormal union and joint ankylosis. The results were excellent in 19 cases, good in 3 cases, and moderate in 1 case according Kolmert's criterion for function ; the effective rate was 95.7%. Conclusion Auto-compressive and anti-circumrotate intramedullary nail has a suitable radian for adult femur, can afford stable fixation, anti-circumrotate and axis compress.