髓内固定技术在骨肿瘤保肢手术中的应用及生物力学分析  

Application and Biomechanical Analysis of Intramedullary Nailing in Limb Salvage Surgery for Bone Tumor

作　　者：李建武[1] 白梅[1] 王军[1] 王臻[2] 白国玺[1] 李占宁[1] 

机构地区：[1]武警陕西总队医院,西安710054 [2]第四军医大学骨科研究所,西安710032

出　　处：《临床误诊误治》2007年第6期14-17,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的：通过153例经髓内固定的保肢手术及相关髓内钉的生物力学实验，对保肢手术中髓内钉的特性及不同髓内钉安装方法、固定效果及并发症进行评价。方法：对1995年5月-2005年8月经髓内手术的153例随访9—116个月，平均30．7个月，灭活后行普通型髓内钉固定54例，内锁髓内钉固定62例，髁上型内锁钉固定37例，并用健康成人股骨12根模拟不同髓内钉内固定法进行生物力学实验，计算机软件分析结果。结果：153例中，普通型髓内钉固定一期愈合率为89％，内锁髓内钉固定一期愈合率为95％，髁上型内锁髓内钉固定一期愈合率为97％。结论：临床资料及生物力学分析均证明保肢手术使用内锁髓内固定，尤其是髁上型内锁髓内钉固定牢固可靠，骨端一期愈合率高，术后并发症明显少于普通型髓内钉（P〈0．05）。Objective：To report the results of internal fixation with intramedullary nail in limb salvage surgery,to discuss the biomechanical character of interlocking nailing. Methods： 153 patients with resection of malignant bone tumor were treated with Intramedullary Nailing in Limb Salvage Surgery,four types of gratis were used for reconstruction of the skeletal defects： Tumor bone replantation in place which extirpated by liquid nitrogen for 13 patients,by radiation for 12 patients, segmental allograft which preservation by deep hypothermia （ -80℃ ） for 112 patients. Results ：153 patients were followed up ranged from 12 to 116 months, the primary bone healing in 143 patients （93.5%） ,Complications were developed in 19.6% patients . Intramedullary fixation by Kuntscher nails in 54 patients,the bone healing rate was 86% ,the interlocking nails fixation in 52 patients, the bone healing rate was 95% ,37 patients with Supracondylar nails ,the bone healing rate was 97%. Conclusion .The interlocking nail had good results in reconstruction of skeletal defects after resection of malignant bone tumor, and the complication is less than Kuntscher nail （P 〈 0. 05 ） , the Supraeondylar nail has the more advantages than others methods （ P 〈 0. 05 ）.

关 键 词：骨肿瘤 内锁髓内钉 髓内固定 保肢手术 生物力学 

分 类 号：R738.1[医药卫生—肿瘤]