髓内扩张自锁钉治疗股骨干骨折51例疗效探讨

目的探讨髓内扩张自锁钉治疗股骨干骨折的临床应用及疗效。方法 2006年1月～2012年6月本院采用髓内扩张自锁钉治疗股骨干骨折51例,其中,股骨中上1/3段6例,中段36例,下1/3段9例;粉碎性骨折13例,斜形骨折22例,横形骨折16例;新鲜骨折49例,陈旧性骨折骨不连2例。并对其骨折范围、手术时间、术中出血量、内固定效果、骨折愈合情况进行回顾性分析。结果经10～18个月（平均12个月）随访,骨折全部愈合;按Klemn功能恢复分级标准,优41例,良6例,可3例,差1例,优良率为92.2%。1例因术后再次跌伤出现骨折端移位造成畸形愈合,无切口感染及内固定失败等并发症发生,骨折愈合时间3～9个月,平均3.6个月。结论髓内扩张自锁钉内固定在治疗股骨干骨折中具有手术时间短、创伤小、出血少、操作简单、固定可靠、骨折愈合率高、并发症少、术后恢复快等特点,符合生物力学要求,是一种较好的内固定方法。

Effect of intramedullary expanded self-locking nail in treatment of femoral shaft fractures in 51 cases

Objective To explore the clinical application and efficacy of the intramedullary expanded self-locking nail for the treatment of femoral shaft fractures. Methods From January 2006 to June 2012, 51 cases of femoral shaft fractures were treated with the nailing procedure, among them, 6 cases had fracture in the upper 1/3 of the femoral shaft, 36 cases in the middle 1/3 and 9 cases in the lower 1/3; 13 cases of comminuted fracture, 22 cases of the oblique fracture, and 16 cases of the transverse fracture; there were 49 cases of fresh fractures and 2 cases of old ones . The range of fractures, operative time, blood loss, within the fixed effects, fracture healing were analyzed retrospectively. Results The 10 to 18 months （averaging 12 months） follow-up showed that all of the cases had union; according to Klemn scoring system, the results were excellent in 41 cases, good in 6 cases, fair in 3 cases, and poor in 1 case, excellent rate was 92.2%.1 case due to postoperative again falls fracture end shift resulted in malunion, no incision infection and internal fixation failure and other complications. The union time was from 3 months to 9 months （average of 3.6 months）. Conclusion The intramedullary expanded self -locking nail is a good internal fixation method to treat fenoral shaft fractures, because it has the characteristics of short operation time, less trauma, less bleeding, simple operation, reliable fixation, high fracture healing rate, fewer complications, rapid postoperative recovery and so on, according to the requirements of the biomechanics.