用可膨胀髓内钉固定治疗肱骨干骨折的疗效分析  

Outcomes of expandable nailing system for humeral shaft fractures

作　　者：何小健[1] 安智全[1] 谢孝兴[1] 姜朝来[1] 

机构地区：[1]上海交通大学附属上海市第六人民医院骨科,上海市200233

出　　处：《中国组织工程研究与临床康复》2009年第17期3347-3351,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：回顾性分析2006-01/2007-12上海交通大学附属第六人民医院骨科收治的肱骨干骨折患者44例,男29例,女15例,年龄19～89岁,平均40.7岁。其中上段骨折13例,中段骨折24例,下段骨折7例,均为闭合性骨折。按AO/ASIF分型:A1型5例,A2型11例,A3型6例,B1型6例,B2型12例,B3型4例。全部患者均采用可膨胀髓内钉治疗。记录自切皮至缝皮的手术时间、术中出血量、术后并发症、骨折愈合时间、肩关节和肘关节屈伸范围。术后摄标准X射线平片观察肩肘关节恢复情况。44例患者均成功采用顺行肱骨可膨胀髓内钉治疗,手术时间30～150min,平均86min。术中出血量30～200mL,平均70mL,除原发损伤导致的桡神经麻痹外全部患者均无医源性桡神经麻痹发生。44例患者均获得随访,平均随访18个月,骨折41例愈合,骨不连3例,平均愈合时间15.8周。15例肩关节有轻微疼痛,但不影响日常生活,肩关节功能按UCLA评分标准,优18例,良23例,可3例,优良率为93.2%。根据Mayo肘关节功能评分标准,所有患者肘关节功能均为优。无感染、医源性骨折、肢体短缩、断钉、脂肪栓塞综合征及周围神经损伤等并发症发生。提示可膨胀髓内钉具有操作方便,手术时间短,出血量少的优点,但顺行插钉易致肩关节疼痛,抗旋转性能欠佳,对于肱骨下段旋转不稳定的骨折宜慎重。From January 2006 to December 2007, 44 cases of humeral shaft fractures were admitted to Department of Orthopaedics, Sixth People＇s Hospital of Shanghai Jiao Tong University, including 29 males and 15 females, with an average age of 40.7 years old （ranging 19 89 years）. Of them, 13 cases of fracture involved upper segment, 24 involved middle segment and 7 lower segment. All fractures were close fractures. According to AO/ASIF classification, there were 5 cases of type A1, 11 of A2, 6 of A3, 6 of B1, 12 of B2, and 4 of B3. All patients were treated by expendable intramedullary nailing system. Time of operation, hospitalization and healing, blood loss, intra- or postoperative complications and range of shoulder and elbow motion were recorded and analyzed statistically. X-ray was shot to observe the union of fractures. The expendable intramedullary nailing was successfully performed in all patients for 86 minutes （ranging 30 150 minutes）. The blood loss ranged from 30 to 200 mL with a mean of 70 mL. Except primary injury-caused radial paralysis, no iatrogenic radial paralysis occurred. All 44 patients were follow-up with an average of 18 months. Of them, 41 patients had fracture union, and 3 nonunion. The average healing time was 15.8 weeks. There were 15 patients complained of pain in the shoulder joint, which did not affect daily life. According to UCLA shoulder scoring system, an excellent result was found in 18 patients, good in 23 patients, and fair in 3 patients with an excellent/good rate of 93.2% All the patients had the excellent results according to Mayo elbow performance score system. No infection, iatrogenic fracture, limb shortening, nail breakage, fat embolism syndrome or peripheral nerve injury was found. The expandable nail offers the advantages of little blood loss, reduced operation time and exposure to radiation. However, nail antegrade insertion may lead to shoulder pain, and it should be paid more attention for cases of rotational instability in inferior segment of the humerus.

关 键 词：肱骨干骨折 可膨胀髓内钉 内固定 

分 类 号：R318[医药卫生—生物医学工程]