自控微动带锁髓内钉在股骨干骨折中的应用VIP免费

ChineseJournalofReparativeandReconstructiveSurgery,June2008,Vol.22,No.6·696·自控微动带锁髓内钉在股骨干骨折中的应用张宏军刘又文高书图杜志谦【摘要】目的为降低带锁髓内钉治疗股骨干骨折延迟愈合和不愈合的发生率，自行设计自控微动带锁髓内钉（auto-controlmicro-motionintramedullarylockingnail，AMLN）并临床应用，观察其临床治疗效果。方法AMLN的远、近端钉体由微动锁定装置连接，其齿状结构可保证骨折间隙有1.0～1.5mm轴向微动，使骨折端早期以及整个骨折愈合过程中始终存在生理性应力刺激与传导。2003年12月－2006年5月，临床应用AMLN治疗股骨干骨折32例。男21例，女11例；年龄20～43岁，平均31.2岁。致伤原因：摔伤3例，砸伤1例，车祸伤28例。左侧13例，右侧19例。新鲜骨折29例，含股骨干上、中、下部位的横形、短斜形、螺旋形及粉碎性Ⅰ、Ⅱ、Ⅲ、Ⅳ型骨折；陈旧性骨折不愈合3例。新鲜骨折采用闭合植入AMLN固定治疗，陈旧性骨折采用开放自体植骨顺行植入AMLN治疗。结果32例获随访8～22个月，平均11.5个月。X线片示骨折愈合时间为4.0～7.5个月，平均5.1个月。患者无髓内钉断裂发生。1例粉碎性骨折患者钉体有轻度弯曲畸形，2例进针点轻度不适。按Klemm功能恢复分级标准：优26例，良5例，可1例，优良率96.88%。结论AMLN设计合理，具有临床应用简便、骨折愈合快的优点，是治疗股骨干骨折的有效方法之一。【关键词】股骨干骨折轴向微动自控微动带锁髓内钉中图分类号：R683.42R687.33文献标志码：AAPPLICATIONOFAUTO-CONTROLMICRO-MOTIONINTRAMEDULLARYLOCKINGNAILINTHETREATMENTOFFEMORALSHAFTFRACTURES/ZHANGHongjun,LIUYouwen,GAOShutu,DUZhiqian.LuoyangOrthopaedicHospital,LuoyangHenan,471002,P.R.China.Correspondingauthor:ZHANGHongjun,E-mail:zdzhj2000@yahoo.com.cn【Abstract】ObjectiveTheauto-controlmicro-motionintramedullarylockingnail(AMLN)isdesigned,toreducetheincidenceofdelayedunionandnon-unionoffemoralshaftfracturesfixedbyinterlockingintramedullarynails,andtoobservetheclinicaleffectofself-designAMLNinthetreatmentoffemoralshaftfractures.MethodsThedistalandpromixalnailswereconnectedbythemicro-motionlockingstructure,whichcouldcause1.0-1.5mmaxialmicro-motionbetweenfracturegaps.Itcouldproducephysicalstimulusandconductionbetweenfracturegapsinthecourseoffractureunion.FromDecember2003toMay2006,32casesoffemoralshaftfracturesweretreatedwithAMLN,including21malesand11femaleswiththeaverageageof31.2years(rangingfrom20yearsto43years).Thetraumaresultedfromfallwoundsin3cases,crashinjuriesin1caseandcaraccidentsin28cases.Twenty-ninecaseswerefreshfracturesindifferentpartsofthefemoralshaftwithtransverse,oblique,spiralandcomminutedfracturesoftypeI,II,IIIandIV.Threecaseswereoldnon-unionfractures.ThefreshfracturesweretreatedbyclosedAMLNfixation,whiletheoldfracturesweretreatedbyopenAMLNnailsafterroutineimplantationofselfbone.ResultsAllthe32caseswerefollowedupfortheaveragetimeof11.5months(rangeingfrom8monthsto22months).TheX-rayfilmsshowedthefractureswerehealed4.0to7.5monthsaftertheoperation,withthemeantimeof5.1months,andnobreakofthenailhappened.Onenailmildlybentinthecomminutedfracture,and2patientsfeltslightlyunwellattheneedlingpoint.AccordingtotheKlemmcriterionforfunction,26caseswereexcellent,5good,1fair,andthechoicenessratewas96.88%.ConclusionWithasuitabledesign,AMLNiseasytoperformandhelpfultoquickenfractureunion,anditiseffectivetotreatfemoralshaftfractures.【Keywords】FemoralshaftfractureAxialmicro-motionAuto-controlmicro-motionintramedullarylockingnail股骨干骨折临床多选用带锁髓内钉内固定治疗，但静态固定状态下骨折延迟愈合和不愈合发生率较高[1-4]。为减少该并发症，我们自行设计了一种自控微动带锁髓内钉...