改进型逆行旋入钉治疗肱骨骨折  

MODIFIED RETROGRADE ROTATIVE-TYPE INTERLOCKING INTRAMEDULLARY NAIL FOR HUMERAL SHAFT FRACTURES

作　　者：王大兴[1] 熊鹰[1] 邓虹[2] 柳百炼[1] 李群辉[1] 张仲子[1] 贾福[1] 

机构地区：[1]昆明医学院附属延安医院骨科,昆明650051 [2]昆明医学院附属延安医院急诊科,昆明650051

出　　处：《中国修复重建外科杂志》2011年第7期811-815,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的根据肱骨的解剖特点及临床应用,改进原有的肱骨逆行旋入式自锁髓内钉(逆行旋入钉),探讨改进型逆行旋入钉对肱骨骨折的临床价值。方法 2006年3月-2010年3月,共收治146例肱骨骨折患者。将患者随机分为2组,每组73例,分别采用原型及改进型逆行旋入钉治疗。原型组:男40例,女33例;平均年龄41岁;骨折类型为横形41例,斜形18例,螺旋形8例,粉碎形6例;受伤至手术时间3 h～2个月,中位时间11 d。手术以闭合方式固定27例,切开复位固定46例。改进型组:男39例,女34例;平均年龄40岁;骨折类型为横形43例,斜形16例,螺旋形10例,粉碎形4例;受伤至手术时间3 h～3个月,中位时间13 d。手术以闭合方式固定31例,切开复位固定42例。两组患者性别、年龄、骨折类型、病程等一般资料比较差异均无统计学意义(P>0.05),有可比性。术后比较两组骨折愈合情况及患肢功能恢复情况。结果改进型组手术时间和术中出血量均少于原型组,差异有统计学意义(P<0.05)。原型组术中出现3例医源性肱骨髁上骨折;改进型组无医源性肱骨髁上骨折发生。两组切口均Ⅰ期愈合,术后未发生感染、内固定物松动和断裂等并发症。两组共116例获12个月以上随访,每组58例。骨折愈合时间:改进型组新鲜骨折(15±3)周,陈旧骨折和骨不连(30±12)周;原型组新鲜骨折(16±4)周,陈旧骨折(35±14)周;两组骨折愈合时间比较差异均有统计学意义(P<0.05)。术后3个月患肢功能评价:原型组Neer肩关节评分优65例、良8例,Aitken和Rorabeck肘关节功能评分优61例、良12例,两种评分优良率均为100%;改进型组Neer肩关节评分优67例、良6例,Aitken和Rorabeck肘关节功能评分优63例、良10例,两种评分优良率均为100%。结论改进型逆行旋入钉手术操作简便、并发症少,是一种有效可靠的内固定器。Objective To improve the retrograde rotative-type lnterlocklng lntrameduuary nail based on numeral bone dissection and clinical application, and investigate the dinical values of modified retrograde rotative-type interlocking intramedullary nail for humeral shaft fracture. Methods Between March 2006 and March 2010, 146 patients with humeral shaft fractures were treated and fractures were fixed with the modified retrograde rotative-type interlocking intrameduUary nail （the modified group, n=73） and with the retrograde rotative-type interlocking intramedullary nail （the original group, n=73）. In the original group, there were 40 males and 33 females with an average age of 41 years; 41 cases were classified as transverse fracture, 18 as oblique fracture, 8 as spiral fracure, and 6 as comminuted fracture; the median disease duration was 11 days （range, 3 hours to 2 months）; and close reduction fixation was performed in 27 cases and open reduction fixation in 46 cases. In the modified group, there were 39 males and 34 females with an average age of 40 years; 43 cases were classified as transverse fracture, 16 as oblique fracture, 10 as spiral fracure, and 4 as comminuted fracture; the median disease duration was 13 days （range, 3 hours to 3 months）; and close reduction fixation was performed in 31 cases and open reduction fixation in 42 cases. There was no significant difference in sex, age, fracture type, and disease duration between 2 groups （P 〉 0.05）. The fracture healing and functional recovery of affected limbs were compared between 2 groups after operation. Results The operation time and intraoperative blood loss in the modified group were significantly less than those in the original group （P 〈 0.05）. Iatrogenic fracture occurred in 3 cases of the original group, which were cleavage fracture of supracondylar. No iatrogenic fracture occurred in the modified group. All incisions of 2 groups healed by first intention without complications of postoperative infections, metal fracture, an

关 键 词：改进型逆行旋入式自锁髓内钉 肱骨骨折 内固定 临床疗效 

分 类 号：R687.3[医药卫生—骨科学]