形状记忆合金环抱器治疗上肢长骨干复杂骨折

Clinical Comparison Study for Treatment of Complex Fractures of Long Bone Stem in Upper Extremity with Shape Memory Alloy Encircling Fixer

目的 评价形状记忆合金环抱器（shape memory alloy encircling fixer，SMAEF）治疗上肢长骨干复杂骨折的疗效，并与动力加压接骨板（dynamic compressive plate，DCP）进行临床对比研究。方法 随机选择2001年6月至2004年12月入院的上肢长骨干复杂骨折75例，分别采用SMAEF（38例）与DCP（37例）进行内固定治疗。经6～30个月（平均16个月）的随访，观察患者骨折愈合和功能恢复情况。比较两组的手术时间、骨愈合时间、伤口感染率、骨不连发生率和疗效优良率。结果 SMAEF组的手术时间明显低于DCP组（P〈0．05），两组的伤口感染率无差异。SMAEF组骨愈合时间显著短于DCP组，骨不连发生率也低于DCP组（P〈0．05）。根据综合评定标准，SMAEF组疗效评定优良率高于DCP组（P〈0．05）。结论 SMAEF具有良好的抗弯曲、抗扭转作用，固定可靠、可早期功能锻炼，有利于骨折愈合；SMAEF内固定术具有创伤小、操作简便和较少应力遮挡效应等优点，是治疗上肢长骨干复杂骨折的理想方法。

Objective To evaluate the therapeutic effects of shape memory alloy encircling fixer （SMAEF） in treatment of complex fractures of long bone stern in upper extremity and explore the clinical advantages and disadvantages of SMAEF in comparison with dynamic compressive plate（I）CP）. Methods 75 cases of complex fractures of long hone stem in upper extremity, admitted from June 2001 to December 2004, were treated randomly with SMAEF or DCP. They were type B1 to C3 according to AO classification. 38 cases were stabilized with SMAEF and 37 cases with DCP. The patients were followed up for 6 to 30 months（mean： 16 months）. The healing process of their fractures were observed regularly by radiography. The cases were compared with respect to operative duration ,wound infection rate, fracture healing time, bone nonunion rate and functional recovery. Results The operative duration for SMAEF group were significantly reduced compared with those for DCP group （P〈0. 05）. There was no significant difference between SMAEF group and DCP group in wound infection after operation. The fracture healing time for SMAEF group was significantly shorter than that for DCP group（P〈0. 05）. Bone nonunion rate of SMAEF group was lower than that of DCP group（P〈0. 05）. The results of functional recovery in SMAEF group were superior to those in DCP（P〈0. 05）. Conclusion SMAEF has prominent function of anti-bend, anti-rotation, reliable fixation and allowing earlier functional exercises, which is beneficial to facilitating fracture healing. Internal fixation with SMAEF is an ideal method in the treatment of complex fractures of long bone stem. It has the advantages of easy manipulation with less surgical trauma and less stress shield effect.