带锁髓内钉治疗肱骨骨折并发症原因分析与对策

Reasons and management of complications of interlocking intramedullary nail for treating humeral fractures

目的分析应用带锁髓内钉治疗肱骨骨折所致并发症的原因，并探讨预防并发症的对策。方法2000年12月至2005年12月应用带锁髓内钉治疗肱骨骨折患者53例，男37例，女16例；年龄17～69岁，平均37．3岁。新鲜骨折41例，陈旧骨折12例。闭合骨折45例，开放骨折8例（Gustilo分型，Ⅰ型6例，Ⅱ型2例）。第二次手术5例，三次手术1例。术中植骨12例。顺行髓内钉内固定41例，逆行髓内钉内固定12例。结果术后通过平均19个月（8～37个月）的随访，出现并发症13例，发生率24．5％。并发症包括：肩关节功能障碍3例，骨不连3例，骨折畸形愈合1例，深部感染1例，医源性骨折1例，桡神经损伤2例，腋神经损伤1例，肘关节功能障碍2例。结论应用带锁髓内钉治疗肱骨骨折有较高的并发症发生率。熟练的操作技术、充分的术前准备、恰当的术中及术后处理，能够有效地预防并发症的发生。

Objective To analyse the complications of interlocking intramedullary nail for treating humeral fractures and its prevention. Methods From December 2000 to December 2005, 53 cases of humeral fractures were treated with interlocking intramedullary nail. There were 37 males and 16 females, with an average age of 37.3 years （ranging from 17 to 69 years）. Forty -one cases were fresh fractures, 12 were old fractures; 45 were close fractures, 8 were open fractures（ 6 Gustilo type Ⅰ , 2 type Ⅱ ）. Six nonunions had previous operation, 12 were treated with bone grafting. Forty -one humeral fractures were treated with antegrade nail, the others were treated by retrograde nail. Results Mean follow - up period was 19 months （ ranging from 8 to 37 months）. There were 13 complications in total, inclucling： 2 shoulder impairment, 3 nonunions, 1 malunions, 1 deep infection, 1 split in intraoperation, 2 elbow impairment, 2 radial nerve and 1 axillary nerve palsy. Conclusion There are higher complications in the interlocking intramedullary nail . It can be prevented throngh improving surgical techniques, careful preparation pre -operatively and careful management intra -operatively and post -operatively.