半圆形动态交锁髓内钉的研制及其固定胫骨中下段骨折的临床应用

作者设计一种半圆形动态交锁髓内钉（ＳＤＬＩＮ）用于胫骨中下段骨折内固定，它是由内、外侧钉组成，两侧钉分别自内踝后份和前踝外份处打入，其中央部分相互咬合，钉尾用横栓连接，形成一整体结构。生物力学测试证实ＳＤＬＩＮ的综合力学性能明显优于动态不扩髓腔胫骨钉（ＤＵＴＮ）、Ｅｎｄｅｒ钉、矩钉。１９９４年１０月～１９９６年２月共治疗３０例胫骨中下段不稳定骨折，术中不需扩髓腔及Ｃ臂Ｘ光机引导，术后不需外固定。２９例获随访３～１９个月，骨折全部愈合。骨折平均愈合时间：闭合性骨折为２．８个月（新鲜）和４．７个月（陈旧性）；开放性骨折３．７个月。按ＪｏｈｎｅｒａｎｄＷｒｕｈ疗效标准，总的优良率９６．６％（闭合性骨折１００％，开放性骨折９２．３％）；无弯、断、退钉及拔钉后再骨折等并发症。初步认为：ＳＤＬＩＮ是一种适用于各型胫骨中下段骨折的较优良的内固定器械。

The Study and Clinical Application of Semicircular Dynamic Locked Intramedullary Nail in the Treatment of Middle and Distal Tibial Shaft Fractures

The authors designed a semicircular dynamic locked intramedullary nail(SDLIN) for the treatment of unstable fracture of the middle and distal tibial shaft. It is composed of a medial nail and lateral nail, inserted into the medullary canal through the posterior portion of the medial malleolus and the lateral portion of the anterior malleolus respectively. The middle segments of both nails bite each other and their tails were connected together by bolt to form a firm unit.The biomechanical experiments with human tibial specimens showed that SDLIN was significantly superior to the dynamic unreamed tibial nail,Ender's nail and Rectangle nail. From October 1994 to February 1996,30 cases of patients were treated with SDLIN without reaming of the medullary canal,using the C arm guidence and plaster fixation.29 were followed up for an average of 10.3 months (ranged 3 to 19 months).All of the fractures healed up, and the average healing time (month) was 2.8 for fresh closed, 4.7 and 3.7 for old and open fractures respectively. There was no nail or bolt failure or refracture. According to Johner and Wruh's criteria, the total excellent and good rate was 96.6% . Preliminary experience shows that SDLIN is good for every kind of middle and distal shaft fractures of the tibia including those 5cm close to the ankle joint.