有限切开交锁髓内钉在长骨骨折翻修术中的应用  

Reoperations of long bone fractures with interlocking intramedullary nails and limited open reductions

作　　者：欧阳晓[1] 王景荣[1] 王培先[1] 王林[1] 周勇[1] 

机构地区：[1]徐州市第三人民医院,江苏徐州221005

出　　处：《中国矫形外科杂志》2008年第2期101-104,共4页Orthopedic Journal of China

摘　　要：[目的]分析长骨骨折内固定手术失败的原因,探讨有限切开交锁髓内钉在长骨骨折翻修术中的应用并评价其临床疗效。[方法]24例长骨骨折内固定手术失败应用有限切开交锁髓内钉治疗的长骨骨折翻修术病例中,股骨15例,其中股骨干骨折14例,股骨髁上骨折1例;男11例,女4例;左侧7例,右侧8例;接骨板螺丝钉折弯1例,断裂6例,普通髓内钉折弯1例,折断2例,螺钉并钢丝固定假关节形成1例,骨折不愈合4例。胫骨7例,均为骨干骨折,男6例,女1例;左侧3例,右侧4例;接骨板螺丝钉断裂3例,外固定架固定失败1例,骨折不愈合3例。肱骨2例,均为骨干骨折且同为左侧和男性,1例为接骨板螺丝钉断裂,1例为普通髓内钉折断。年龄18～68岁,平均43.7岁。全部病例使用有限切开交锁髓内钉固定并采用自体髂骨或同种异体骨植骨。[结果]经平均25个月(12～35个月)的随访,全部病例获骨性愈合,无髓内钉下沉及折钉或断钉等并发症发生。在股骨和胫骨骨折翻修术的病例中,根据Karlstrom膝关节功能评价标准,优18例,良2例,可1例,差1例。在肱骨骨折翻修术的病例中,根据韩一生肩关节功能评价标准,优1例,良1例。[结论]有限切开交锁髓内钉是长骨骨折翻修术的较理想方法。[ Objective] To investigate the causes of failures of long bone fractures with internal fixations and to study the treatments and effects of reoperations of long bone fractures with inter-locking intramedullary nail and limited open reduction. [ Method] Twenty-four patients of failures of long bone fractures with internal fixations were retreated with inter-locking intramed- ullary nail and limited open reduction. There were 15 cases of femoral fracture,7 cases of tibial fracture and 2 cases of humerus shaft fracture. Of the femoral fracture,there were 14 cases of fractures of shafts of femurs and 1 case of supracondylar fracture of femur;11 male, 4 female ;7 left cases,8 fight cases;1 case complicated with bending of bone plate and screw,6 cases with breakages of plate; 1 case with bending of common intramedullary nail, 2 cases with breakages of common intramedullary nails, 1 case of screw and wire lock fixation complicated with pseudoarticulation formation ,4 cases with nonunion of fracture. Of the cases of tibial shaft fracture, there were 6 male, 1 female;3 left cases, 4 righe cases; 3 cases complicated with breakages of bone plate and screw, 1 case with failure of external fixator,3 cases with nonunion of fracture. Of the cases of humerus shaft fracture, there were 2 cases of male and left ones ; 1 case complicated with breakage of bone plate and screw, 1 case with breakage of common intramedullary nail. The ages of patients ranged from 18 to 68 years old with mean ages 43.7 years old. All fixation failure cases were retreated with inter-locking intramedullary nails and limited open reductions with autogenous iliac bone grafts or bone allografts. [ Result] The average follow-up time was 25 months（ 12 -35 months）. All cases were cured with bone unions. Complications with submerge, breakages and bending of intramedullary nails did not occur. In the reoperating cases of femoral and filial fractures, the knee function were excellent in 18 cases,good 2 cases,fair 1 case and poor 1 case according to Karlstrom

关 键 词：再手术 内固定失败 长骨骨折 交锁髓内钉 

分 类 号：R687[医药卫生—骨科学]