自控微动带锁髓内钉在股骨干骨折中的应用

APPLICATION OF AUTO-CONTROL MICRO-MOTION INTRAMEDULLARY LOCKING NAIL IN THE TREATMENT OF FEMORAL SHAFT FRACTURES

目的为降低带锁髓内钉治疗股骨干骨折延迟愈合和不愈合的发生率,自行设计自控微动带锁髓内钉(auto-control micro-motion intramedullary locking nail,AMLN)并临床应用,观察其临床治疗效果。方法AMLN的远、近端钉体由微动锁定装置连接,其齿状结构可保证骨折间隙有1.0～1.5 mm轴向微动,使骨折端早期以及整个骨折愈合过程中始终存在生理性应力刺激与传导。2003年12月-2006年5月,临床应用AMLN治疗股骨干骨折32例。男21例,女11例;年龄20～43岁,平均31.2岁。致伤原因:摔伤3例,砸伤1例,车祸伤28例。左侧13例,右侧19例。新鲜骨折29例,含股骨干上、中、下部位的横形、短斜形、螺旋形及粉碎性Ⅰ、Ⅱ、Ⅲ、Ⅳ型骨折;陈旧性骨折不愈合3例。新鲜骨折采用闭合植入AMLN固定治疗,陈旧性骨折采用开放自体植骨顺行植入AMLN治疗。结果32例获随访8～22个月,平均11.5个月。X线片示骨折愈合时间为4.0～7.5个月,平均5.1个月。患者无髓内钉断裂发生。1例粉碎性骨折患者钉体有轻度弯曲畸形,2例进针点轻度不适。按Klemm功能恢复分级标准:优26例,良5例,可1例,优良率96.88%。结论AMLN设计合理,具有临床应用简便、骨折愈合快的优点,是治疗股骨干骨折的有效方法之一。

Objective The auto-control micro-motion intramedullary locking nail （AMLN） is designed, to reduce the incidence of delayed union and non-union of femoral shaft fractures fixed by interlocking intramedullary nails, and to observe the clinical effect of self-design AMLN in the treatment of femoral shaft fractures. Methods The distal and promixal nails were connected by the micro-motion locking structure, which could cause 1.0-1.5 mm axial micro-motion between fracture gaps. It could produce physical stimulus and conduction between fracture gaps in the course of fracture union. From December 2003 to May 2006, 32 cases of femoral shaft fractures were treated with AMLN, including 21 males and 11 females with the average age of 31.2 years （ranging from 20 years to 43 years）. The trauma resulted from fall wounds in 3 cases, crash injuries in 1 case and car accidents in 28 cases. Twenty-nine cases were fresh fractures in different parts of the femoral shaft with transverse, oblique, spiral and comminuted fractures of type Ⅰ, Ⅱ, Ⅲ and Ⅳ. Three cases were old non-union fractures. The fresh fractures were treated by dosed AMLN fixation, while the old fractures were treated by open AMLN nails after routine implantation of self bone. Results All the 32 cases were followed up for the average time of 11.5 months （rangeing from 8 months to 22 months）. The X-ray films showed the fractures were healed 4.0 to 7.5 months after the operation, with the mean time of 5.1 months, and no break of the nail happened. One nail mildly bent in the comminuted fracture, and 2 patients felt slightly unwell at the needling point. According to the Klemm criterion for function, 26 cases were excellent, 5 good, 1 fair, and the choiceness rate was 96.88%. Conclusion With a suitable design, AMLN is easy to perform and helpful to quicken fracture union, and it is effective to treat femoral shaft fractures.