采用阻挡螺钉改善顺行交锁髓内钉固定效果治疗股骨干中下段骨折  

Using Blocking Screws to Improve Antegrade Interlocking Intra-medullary Nail′s Fixation Effect in the Treatment of Femoral Lower-middle Section Fracture

作　　者：郑栋[1] 徐南伟[1] 刘瑞平[1] 牛文利[1] 赵公吟[1] 

机构地区：[1]南京医科大学附属常州第二人民医院,江苏常州213000

出　　处：《中国医药指南》2013年第32期310-312,共3页Guide of China Medicine

摘　　要：目的探讨阻挡螺钉改善股骨干中下段骨折顺行交锁髓内钉固定的效果,同时比较股骨顺行交锁髓内钉和逆行交锁髓内钉固定在治疗股骨干中下段骨折时对膝关节功能影响的差异。方法回顾分析2009年6月至2012年6月股骨干中下段骨折患者共52例。其中使用股骨顺行交锁髓内钉结合阻挡螺钉固定组患者28例,而在该组内部分患者是一期手术即加用阻挡螺钉,另一部分患者是二期增加阻挡螺钉固定。对照组使用逆行交锁髓内钉未采用阻挡螺钉固定组患者24例。所有患者术后随访12-20个月,对骨折愈合后患者膝关节功能进行Merchant评分测定。结果采用顺行交锁髓内钉结合阻挡螺钉固定的患者随访时间内骨折全部愈合,恢复良好。其中,一期手术未采用阻挡螺钉的患者,在改为动力化固定并加用阻挡螺钉后骨折断端的稳定性明显得到了改善,骨折的愈合加速。逆行交锁髓内钉未采用阻挡螺钉固定组患者出现关节腔内感染1例,后经冲洗引流后好转。2例患者术后出现关节内游离体。4例在其随访时间内骨折未愈合。其中3例断端出现硬化骨不连,再次手术更换髓内钉,并进行滑槽植骨,加用阻挡螺钉;另1例内固定断裂后再骨折,改用LISS钢板固定并植骨。研究发现,逆行髓内钉未采用阻挡螺钉组,手术并发症发生率远高于前组。同时我们对骨折愈合后的患者膝关节功能行Merchant评分,发现两组患者膝关节功能差异有统计学意义（P〈0.05）。结论在治疗股骨干中下段骨折时,阻挡螺钉能改善顺行交锁髓内钉固定效果增加骨折断端固定的稳定性,促进骨折愈合。较逆行髓内钉固定相比,顺行髓内钉固定能避免对正常膝关节结构的破坏,保护膝关节功能,同时避免取内固定时膝关节的二次损伤。Objective To discuss the therapeutic effect of blocking screws, when they were used to improve femoral antegrade interlocking intra-medullary nail＇s fixation, and to compare different influence of the knee joint between femoral antegrade intra-medullary nail and retro-grade intra-medullary nail. Method From June 2009 to June 2012, we chosed 52 patients with femoral lower-middle section fracture. Among these patients, 28 cases were fixed with antegrade intra-medullary nails combined with blocking screws, some in one-stage operation and other in two-stage operation. 24 cases were fixed with retro-grade intra-medullary nails. All of these two groups＇ patients were followed up for 12-20 months. Furthermore, their knee joint Merchant scores were assessed after bone fractures cured. Result Fractures of first group, who were received the fixation of antegrade intra-medullary nails combined with blocking screws, were all cured completely during the follow-up. Some two-stage operation patients, their fracture fixation were improved obviously after adopting blocking screws in motorization. But there were 4 cases in another group, whose fractures were still not healed during the follow-up.1 cases with infection in the knee joint, another 2 case with joint loose bodies. Surgical complication rate was far higher than the previous group. When the knee Merchant scores were assessed, statistical meaning was found between two groups＇ difference（P〈0.05）. Conclusion Blocking screws can improve antegrade intra- medullary nail fixation effect, increase the stability of fracture and promote the healing. Compared with retro-grade intra-medullary nail, antegrade intra- medullary nail can avoid the injury of knee normal structure and protect knee joint function.

关 键 词：阻挡螺钉 顺行交锁髓内钉 逆行交锁髓内钉 股骨骨折 

分 类 号：R683.42[医药卫生—骨科学]