改良 V型或梅花髓内钉在临床应用中的价值

[目的] 总结和分析改良交锁髓内钉在治疗骨纤维异样增殖症、骨囊肿合并病理骨折、长骨转移癌合并病理骨折和上、下肢骨折的临床应用价值和疗效. [方法 ]将普通 V型或梅花髓内针,经加工改良成交锁髓内钉,对部分上述患者作内固定治疗.[结果] ①骨纤维异样增殖症 16例,其中 7例清除病灶后再行畸形段截骨矫形,所有病例病灶清除 植骨后用改良髓内锁钉固定;骨囊肿合并病理骨折 12例,全部病例病灶彻底清除 植骨后用改良髓内锁钉固定,术后随访病灶愈合良好,未见复发,肢体功能满意.②长骨转移癌合并病理骨折 15例,用改良髓内锁钉进行姑息固定手术,达到稳定肢体的目的,效果满意. ③ 15例骨折对位、对线良好,其中 9例接近解剖复位, 6例达功能复位标准,肢体未见缩短或旋转畸形,术后无并发症,愈合时间 2.5～ 7个月,平均 3.5个月,肢体功能恢复正常.[结论] 改良交锁髓内钉同样具备市售交锁髓内钉防旋转、防分离和重叠移位的作用,手术操作简单,价格低廉,特别适合于经济承受能力差的患者;用于骨纤维异样增殖症和骨囊肿矫形术后的内固定,效果良好;对合并病理性骨折的长骨转移癌能达到临时固定、缓解症状的目的;对骨折断端的加压效应有利于骨折愈合;临床疗效满意,具有推广价值.

Clinical Application of Modified Interlocking Intramedullary Nail

ObjectiveTo analyze and summarize the value and effects of modified interlocking intramedullary nail (MIIN) in the treatment of fibrous dysplasia of bone, bone cyst with pathologic fracture, bone metastasis cancer with pathologic fracture, and fracture of upper and lower limbs. MethodsTo convert the plum-blossom shaped and V-shaped intramedullary nail into the modified interlocking intramedullary nail (MIIN). With the MIIN as a means of intramedullary fixation, 16 cases with fibrous dysplasias of bones, 12 cases of bone cysts with pathologic fractures, 15 cases of bone metastasis cancers with pathologic fractures, and 15 fracture cases of upper and lower limbs were treated. Results(1) The MIINs were planted to fix the bones in the first two patient groups after the pathological tissues with fibrous dysplasia and bone cyst were resected and bone grafts performed in all 28 cases, among whom 7 cases were reshaped on the deformation bone shaft. All the cases were followed-up for 7 to 102 months. The pathological changes disappeared; the fractures healed up and the function of the limbs was good. The complications included one fracture during operation, one rejection for the allograft bone, one broken nail and one curved nail after several months. (2) Fifteen cases of bone metastasis cancer with pathologic fractures were fixed satisfactorily with MIINs and pain was reduced. All the cases were followed-up for 3 to 25.2 months. The average survival time was 8 months. (3) In the fracture cases, the limbs were stable after the fixation with MIINs. Nine out of the 15 cases achieved anatomic reduction, and 6 achieved functional reduction. No complication occurred after the operations. All cases were followed-up for 6 to 60 months and all the fractures healed in 2.5 to 7 months, with restoration of the normal function of limbs. ConclusionAs an internal fixation device, the MIIN can effectively prevent the rotation, separation and overlapping displacement of the bones. It also has a special compression effect on the fixation of fractures. It can be used as an internal fixation nail in some bone orthomorphias and metastasis cancers with pathologic fractures. It is very cheap and easy to operate. It is recommendable for clinic.