可膨胀髓内钉置入内固定治疗肱骨干骨折33例  

Expandable intramedullary nail for humeral shaft fractures in 33 cases

作　　者：苏琰[1] 张长青[1] 蔡培华[1] 陈东[1] 曾炳芳[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海市200233

出　　处：《中国组织工程研究与临床康复》2010年第52期9865-9868,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:交锁髓内钉在长骨中段骨折的治疗中已经成为金标准,但由于个体髓腔的差异,髓内钉在插入前往往通过扩髓来满足操作需要。扩髓不仅破坏骨内膜的血供,还会导致骨强度降低,增加脂肪栓塞的风险。目的:观察可膨胀髓内钉置入内固定治疗肱骨干骨折的效果。方法:2005-01/2009-12上海交通大学附属第六人民医院骨科采用可膨胀髓内钉治疗肱骨干骨折33例,其中20例采用闭合复位,12例有限切开复位,1例行切开复位,顺行插入可膨胀髓内钉固定。可膨胀髓内钉置入48h后,在前臂吊带保护下开始活动临近关节。根据肩关节功能、活动范围、疼痛程度,采用Constant评分进行功能评估。结果与结论:全部病例均获临床随访,随访时间4～12个月,平均7.8个月。均达到骨性愈合,骨折愈合时间为10～15周,平均12.5周。根据肩关节功能Constant评分,优20例,良9例,可3例,差1例,优良率达87.88%。无感染、断钉、脂肪栓塞、骨折不愈合与畸形愈合等情况发生。提示可膨胀髓内钉置入内固定治疗肱骨干骨折能比较有效地维持骨折稳定性,并发症少。BACKGROUND：Interlocking intramedullary nail has become gold standard for humeral shaft fractures. However,individual medullary cavity requires cavity expanding before inserting nail,which damages blood supply,reduces bone density and increases risk for fat embolism. OBJECTIVE：To evaluate the efficacy of expandable intramedullary nail for humeral shaft fractures. METHODS：From January 2005 to December 2009,33 cases of humeral fracture were treated by expandable intramedullary nail. There were 20 cases of close reduction,12 of limited open reduction and 1 of open reduction. The expandible intramedullary nails were inserted through antegrade approach. After 48 hours of nail insertion,adjacent joints moved under protection of forearm mitella.Constant score was used to evaluate function based on shoulder function,range of motion,and pain degree. RESULTS AND CONCLUSION：All patients were followed up for 7.8 months （range 4 to 12 months）. All cases obtained bone union and the mean union period was 12.5 weeks （range 10 to 15 weeks）. According to Constant＇s functional and radiological scoring system,20 were evaluated as excellent,9 as good,3 as fair and 1 was poor. The rate of excellent and good results was 87.88%. No infection,nail breakage,fat embolism,nonunion or malunion occurred. The humeral shaft fractures can be treated with expandable intramedullary nail,which offers enough stability,less invasion,simple manipulation and few complications.

关 键 词：可膨胀髓内钉 肱骨干骨折 骨折固定 复位 并发症 

分 类 号：R318[医药卫生—生物医学工程]