髓内持骨加压髓内钉治疗下肢骨干骨折的临床研究

Clinical Study of Intramedullary Controlled Dynamic Nail for the Treatment of Shaft Fracture of Lower Limb

目的探讨髓内持骨加压髓内钉治疗下肢骨干骨折的疗效,与传统交锁髓内钉比较临床效果。方法回顾2007年12月至2009年9月番禺区中心医院骨科与广州中山大学附属第六医院骨科合作,共收集267例下肢骨干骨折采用髓内钉系统治疗,包括股骨骨干和胫骨骨干。病例其中男171例,女96例;年龄17～72岁,平均35.2岁。按AO分型均为A或B型。应用髓内持骨加压髓内钉组118例,其中A型85例,B型33例;传统交锁髓内钉组149例,其中A型108例,B型41例。结果髓内持骨加压髓内钉组获随访104例,传统交锁髓内钉组147例获得随访,随访时间5～13个月,平均10.2个月。髓内持骨加压髓内钉组:按Johner-Wruhs方法评价功能,优70例,良28例,中7例,差2例,优良率91.3%。传统交锁髓内钉组:按Johner-Wruhs方法评价功能,优86例,良52例,中10例,差1例,优良率92.5%。结论髓内持骨加压髓内钉系统用于治疗下肢骨干骨折具有操作简单,手术时间短、锁钉容易及创伤小的特点。适合在基层医院推广应用,但必须严格控制适应证。

Objective To investigate the effect of intramedullary controlled dynamic nail for the treatment of shaft fracture of lower limb,and to compare the effect with the traditional locked intramedullary nail.Methods According to the datas from the orthopedic department of Panyu central hospital and the 6th affiliated hospital of Sun Yat-sen University from December 2007 to September 2009,267 patients（171 male,96 female;aged 17～72 years,35.2 years on average） with the shaft fracture of lower limb were treated with the intramedullary nail,and the effect of the nail was evaluated.According to the AO classification,the patients were typed as Type A or Type B.And the patients were divided into intramedullary controlled dynamic nail（ICDN） group（118 patients,85 cases with A-type,33 cases with B-type） and the traditional locked intramedullary nail（TLIN） group（149 patients,108 cases with A-type,41 cases with B-type）.Results 104 patients in ICDN group and 147 patients in the TLIN group were followed up after operation.The follow-up time was 5 ～ 13 months with an average of 10.2 months.In the ICDN group,by evaluation function of the Johner-Wruhs method,the results showed that excellent in 70 patients,good in 28 patients,fair in 7 patients and poor in 2 patients,with excellent and good rate of 91.3%.In the TLIN group,by evaluation function of the Johner-Wruhs method,the result showed that excellent in 86 patients,good in 52 patients,fair in 10 patients and poor in one patient,with excellent and good rate of 92.5%.Conclusion The intramedullary controlled dynamic nailing for the treatment of shaft fracture of lower limb has advantages of simple operation,shorter operation time,easy-locked and fewer complications,which is worth popularizing in the primary hospitals with strictly controlled indication.