逆形交锁髓内钉内固定治疗狭部以远股骨干骨折的临床评价

Clinical evaluation of retrograde interlocking intramedullary nail for internal fixation of the femoral shaft fractures distal to the isthmian

[目的]评价逆行交锁髓内钉（RIIN）内固定治疗狭部以远股骨干骨折的临床疗效。[方法]对1999年10月～2005年1月使用RIIN治疗37例（39肢）狭部以远股骨干骨折的疗效进行回顾性分析，其中开放性骨折8肢，闭合性骨折31例，均行静力固定。[结果]随诊8～24个月，平均15个月。发生浅表感染2肢。39肢均达骨性愈合，骨折愈合时问9-20周，平均15周。无深部感染、畸形愈合、主钉及锁钉断裂等并发症发生。Merchan功能评定优良率94．9％。[结论]RIIN内固定治疗狭部以远股骨干骨折具有良好的生物力学性能，骨折愈合率高且并发症少，严格操作规程和术后早期积极功能锻炼是治疗成功的关键。

[ Objective] To evaluate the clinical effects of retrograde interlocking intramedullary nail （RIIN） for internal fixation of the femoral shaft fractures distal to the isthmian. [ Method] Thirty-seven cases （39 limbs） of femoral shaft fractures distal to the isthmian were treated with RIIN from October 1999 to January 2005. Their outcomes were reviewed retrospectively. There were 8 limbs of open fracture and 31 limbs of close fracture. All fractures were fixed statically. [ Result] All patients were followed up for 8 - 24 months, with the average time of 15 months. Two limbs suffered suoerficical infection, all limbs had bony union within 9 -20 weeks, with the average time of bone union＇of 15 weeks. No deep part infection, malunion and nail failure were observed. The rate of being excellence with Merchan evaluation was 97.4%. [ Conclusion] Internal fixation with RIIN for femoral shaft ftractures distal to the isthmian can demonstrating good biomechanic property lead to high union rate of fracture with less complications. The technique of RIIN must be performed strictly during operation and early active functional rehabilitation is the key to obtain good isthmion clinical result.