带锁髓内钉与骨延长器联合应用在小腿延长中的作用  

Combined external skeletal fixation instrumentation with locked intramedullary nailing for tibia lengthening

作　　者：夏和桃[1] 彭爱民[1] 罗先正[2] 秦泗河 韩义连[1] 张保中[4] 石文元[1] 

机构地区：[1]北京骨外固定技术研究所,100039 [2]首都医科大学附属友谊医院骨科 [3]北京市朝阳区矫形外科医院 [4]北京协和医院骨科

出　　处：《中华外科杂志》2005年第8期495-498,共4页Chinese Journal of Surgery

摘　　要：目的探讨带锁髓内钉与骨延长器联合应用对缩短骨延长器的使用时间,提高肢体延长质量,避免短缩、弯曲、扭转畸形等并发症发生的作用.方法共对412个小腿骨行延长术,联合应用骨延长器与带锁髓内钉,在安放髓内钉时只插入近端锁钉,达到计划延长长度后再插入远端锁钉,拆除延长器,进行功能康复.结果共行412个小腿骨延长术;延长长度为3～18 cm,平均7.6 cm.延长器的使用时间平均20 d/cm.新生骨矿化时间平均56 d/cm.3个胫骨发生骨不连,1例踝关节发生内翻畸形,均经第2次手术治愈.结论此种方法可明显缩短骨延长器的使用时间,防止新骨的短缩、弯曲畸形和再骨折等并发症,显著提高肢体延长的质量,是肢体延长的一种新的选择.Objective To shorten the time of external skeletal fixation on legs,and enhance quality of limb lengthening,avoid complications of shortening,bending,twisting and etc. Methods Insert pin transcortical to attack external skeletal fixation simultaneously, put un-reaming locked intramedullary nail (do not insert distal locked screw) into endosteum of lengthening bone. After the legs achieved predetermined length, insert distal locked screw and then remove external skeletal fixation, locked intramedullary nail,then maintain consolidation of rehabilitation. Results The group lengthened legs for 412 cases. The range of lengthening was 3 to 18 cm. Mean length was 7.6 cm. The mean time for needed external skeletal fixation was 20 d/cm. The mean time of osteogenesis was 56 d/cm. For complications, there were 3 tibias ununion cases and 1 varus ankel. All cases were treated undergoing twice. Conclusions The method reduces the time for needed external skeletal fixation visibly, enhances the quality of limb lengthening remarkably, prevents complications of shortening new bone, deformity, bending and re-fracture which do not effect the healing time. This is a new choice of limb lengthening.

关 键 词：带锁髓内钉 骨延长器 小腿延长 肢体延长 第2次手术 扭转畸形 远端锁钉 功能康复 骨延长术 内翻畸形 并发症 时间 小腿骨 平均 骨矿化 骨不连 骨发生 踝关节 再骨折 缩短 质量 短缩 弯曲 长度 cm 

分 类 号：R687.3[医药卫生—骨科学]