顺行髓内钉固定治疗12-A型肱骨干骨折中医源性骨折的研究  

Iatrogenic fractures following treatment of type 12-A humeral shaft fractures with antegrade intrameduHary nails

作　　者：崔智勇 田耘[1] 冯辉 祝腾蛟 张志山[1] 姬洪全[1] 

机构地区：[1]北京大学第三医院创伤骨科,100191

出　　处：《中华创伤骨科杂志》2018年第1期10-15,共6页Chinese Journal of Orthopaedic Trauma

基　　金：北京市科学技术委员会基金（A71479-05）

摘　　要：目的对顺行髓内钉固定治疗肱骨干骨折时所造成的医源性骨折进行描述，并分析导致这种医源性骨折的原因。方法回顾性分析2006年10月至2017年3月期间采用顺行髓内钉固定治疗的12．A型肱骨干骨折患者资料。男13例，女13例；年龄为22—76岁，平均44．5岁；合并其他部位骨折或桡神经损伤6例。根据有无发生医源性骨折将患者分为医源性骨折组和无医源性骨折组，比较两组患者的性别、年龄、骨折AO分型、扩髓病例数及骨折不愈合情况等。结果26例患者术后获13～182周（平均63．8周）随访。26例患者中，7例发生医源性骨折，4例骨折不愈合。22例骨折正常愈合患者的愈合时间为9～29周，平均14．6周。医源性骨折组7例患者均扩髓，而无医源性骨折组19例患者中9例患者扩髓；医源性骨折组3例患者发生骨折不愈合，而无医源性骨折组仅有1例患者发生骨折不愈合，以上项目两组之间比较差异均有统计学意义（P〈0．05）。两组患者的性别、年龄、髓内钉直径、骨折AO分型、近远端螺钉锁定方式及二次手术率等比较差异均无统计学意义（P〉0．05）。结论顺行髓内钉固定治疗12．A型肱骨干骨折会造成医源性骨折，该医源性骨折影响骨折愈合，且术中扩髓可能是造成该医源性骨折的危险因素。Objective To analyze the iatrogenic fractures following treatment of type 12-A humeral shaft fractures with antegrade intramedullary nails. Methods We reviewed the patients who had been treated with antegrade intramedullary nails for type 12-A humeral shaft fracture from October 2006 to March 2017. They were 13 males and 13 females with an age range from 22 to 76 years and an average age of 44.5 years. Six of them were complicated with other fractures or radial nerve injury. We divided the patients into an iatrogenie fracture （IF） group and a non-iatrogenic fracture （NIF） group and compared gender, age, fracture type, reaming and nonunion between the 2 groups. Results The follow-up time for the 26 patients ranged from 13 to 182 weeks （63.8 weeks on average）. Of them, 7 suffered iatrogenic fracture and 4 nonunion. The union time for the other 22 patients ranged from 9 to 29 weeks （14. 6 weeks on average）. All the 7 patients in the iatrogenic fracture group were treated with reaming while only 9 of the 19 patients in the non-iatrogenic fracture group were treated with reaming. Nonunion occurred in 3 patients in the iatrogenic fracture group but in only one patient in the non-iatrogenic fracture group. All the above comparisons were statistically significant between the 2 groups （ P 〈 0. 05） but there were no significant differences in comparisons between the 2 groups regarding gender, age, nail diameter, fracture type, way of locking proximal and distal screws or rate of secondary surgery （ P 〉 0. 05） . Conclusions Antegrade intramedullary nailing may＂ cause an iatro- genie fracture in the treatment of typel2-A humeral shaft fractures. The iatrogenic fracture may affect fracture union. Intraoperative reaming may be the risk factor for the iatrogenic fracture.

关 键 词：肱骨骨折 骨折固定术 髓内 骨钉 医源性骨折 扩髓 

分 类 号：R687.3[医药卫生—骨科学]