有限切开复位带锁髓内钉治疗股骨干粉碎性骨折

Comminuted fracture of femoral shaft treated with interlocking medullary nail and limited open reduction

目的:探讨有限切开复位,逆行扩髓,带锁髓内钉治疗股骨干粉碎性骨折的可行性及临床疗效。方法:本组96例(101侧),男63例,女33例;年龄18-65岁,平均33.5岁,全部为股骨干粉碎性骨折。按AO分类:B3型45例,C1型36例,C2型9例,C3型6例;其中开放性骨折9例,Ⅰ度8例,Ⅱ度1例。所有病例均采用有限切开复位,切口长度6-10 cm,平均8.2 cm,逆行扩髓,静力型固定,尽量保护骨折碎片血运,不苛求骨折碎片的解剖复位,但要尽量靠近主骨块。结果:全部病例均得到随访,随访时间6-18个月,骨折全部愈合,平均愈合时间6.4个月,1例深部感染。结论:对股骨干粉碎性骨折采用有限切开复位带锁髓内钉内固定技术具有操作简单、骨折复位好、手术时间短等优点,严格掌握适应证,熟练手术操作技术,可获得满意疗效。

Objective: To investigate the pracitcability and clinical effects of interlocking medullary nail and limited open reduction in the treatment of comminuted femoral shaft fracture. Methods:ninty-six patients (101 femoral shaft) were all comminuted femoral shaft fractures. There were 63 cases of males,33 cases of females. The mean age was 33.5 years ( range 18-65 years) . According to AO classification: 45 cases were B3, 36 cases were C1 ,9 cases were C2 ,6 cases were C3. 9 cases were open fractures (8 cases were degree Ⅰ and one case was degree Ⅱ ). All cases were treated with interlocking medullary nail and limited open reduction. The average length of the incision was 8.2 cm (range 6-10 cm). Retro grade reaming,elastic fixation,trying to keep circulation at the fracture sites and not absolute reduction were benefit for fracture healing. Results: All the cases were followed up from 6 to 18 months. All fracture union, the average healing time was 6.4 months. The complications included one deep infection. Conclusion: The treatment of comminuted femoral shaft fracture with interlocking medullary nail and limited open reduction have the advantages of easy to manipulate, short operating time,better reduction,high rate of fracture healing.We have obtained the satisfactory results, as the timing of operation and indications are appropriate and the technique of operation is practised.