可膨胀髓内钉治疗肱骨干骨折

The application of expandable intra-medullary nail system for treatment of humeral shaft fracture

目的探讨可膨胀髓内钉FixionTM系统在肱骨干骨折中的应用方法和临床疗效。方法自2004年8月至2006年4月期间,采用可膨胀髓内钉FixionTM系统共治疗26例肱骨干中1/3骨折病人,其中男17例,女9例;年龄20～71岁(平均46岁),均为闭合骨折;新鲜骨折19例,陈旧性骨折5例,病理性骨折2例。结果手术时间29～62min(平均41min),术中出血量20～180ml(平均90ml),平均随访时间为11个月,平均愈合时间为13周;肩关节功能按Neer评分,结果优17例,良5例,可4例;其中2例术后早期出现明显的上臂胀痛,1例新鲜骨折在术后26周时摄片仍可见骨折线。结论可膨胀髓内钉根据髓腔解剖特点呈沙漏样固定,应力分布更均匀;操作更简单,可减少创伤与出血量、缩短手术时间、减少医生与病人接受的X线剂量;轴向弹性固定可加快骨折愈合时间。在掌握好适应证和正确操作的前提下,可膨胀髓内钉FixionTM系统是治疗肱骨干骨折最理想的方法之一,尤其适用于伴有骨质疏松的病人。

Objective To report the technique and clinical results of the expandable intra medullary nail system FixionTM for humeral shaft fracture. Methods During August 2004 and April 2006, 26 cases of humeral shaft fracture were treated by expandable intra-medullary nail system FixionTM. There were 17 males and 9 females whose age ranged from 20 to 71 years old（averaged 46 years old）. All of the cases were closed fractures, 19 cases were fresh fractures, 5 cases were dated and 2 cases were pathologic. Results The surgical time ranged from 29min to 62min（averaged 41min） and the blood ions ranged from 20ml to 180ml（averaged 90ml）. All of them were followed up for 11 months in average. The time to fracture union was 13 weeks in average. After evaluated according to the criteria of Neer＇s score, there were 17 cases assessed as being excellent, 5 cases as good and 4 cases as fair. 2 cases had ache of upper arms early after the surgery. One cases of fresh fractures still had line on X-ray when 26 weeks after the surgery. Conclusions By using the expandable intramedullary nail system, highly resistant to the rotational strength was achieved due to the ＂hour-glass＂ anatomical character, and it is a minimal invasive insertion technique which can significantly reduce the surgical time, it can also reduce the blood loss and the time that exposed under X-ray. Due to the abutment of the longitudinal bars along the entire length of the medullary canal, the time to fracture union can be decreaced. In summery, we believed the Fixation expandable intra-medullary nail provides many advantages to conventional interlocking IM nail in treatment of humeral shaft fracture, especially for patients with osteoporosis when used for the correct indication and surgical technique.