带锁髓内钉治疗肱骨病理性骨折

Treatment of pathdogical fractures of the humerus with a locked intramedullary nail

目的评估带锁髓内钉治疗肱骨病理性骨折和即将发生的病理性骨折的效果。方法对12例肱骨干转移性肿瘤患者进行肱骨带锁髓内钉固定,其中病理性骨折10例,潜在病理性骨折2例;顺行穿钉法9例,逆行穿钉法3例,2例患者用骨水泥加强,所有患者均进行辅助治疗(放疗或化疗)。结果4例出现并发症,2例为逆形穿钉时术中发生骨折,1例为术后锁钉处骨折,1例患者出现远端锁钉困难。另有2例局部病变进展恶化。75%的患者使用带锁髓内钉使肱骨获得稳定。结论带锁髓内钉治疗肱骨干转移性肿瘤,可提高患者的生存质量;逆行穿钉法增加术中并发骨折的风险。

Objective To assess the effect on the use of a locked humeral nail to treat pathological fractures and impending pathological fractures of the humerus. Methods Twelve patients with the metastasis of the diaphysis of the humerus received the locked intramedullary humeral nails ： 10 for pathological fractures and 2 for impending fractures ;9 nails were inserted anterograde and 3 retrograde. Cement augmentation was applied in 2 patients, and adjuvant therapy （radiotherapy or chemotherapy） was used in 12 patients. Results Complications occurred in 4 patients. 2 due to intraoperative fractures during retrograde nailing, 1 due to a fracture through screw holes postoperatively. Difficulty in distal locking of the nail was encountered in 1 patient, and 2 due to local progression of disease ,locked intramedullary nailing resulted in a stable humerus in 75% of patients. Conclusion The use of a locked humeral nail to treat the metastasis of the diaphysis of the humerus can improve the patient＇s qualith of life. Retrograde insertion of the nail is associated with an increased risk of intra - operative fracture.