带锁髓内针与旋入髓内针治疗股骨干骨折的病例对照研究

The comparisive study of the clinical effect of rotary self-locking intramedullary nail and intramedullary interlocking nail for the treatment of femur fracture

目的:就带锁髓内针与旋入式髓内针治疗股骨干新鲜骨折的临床疗效等方面进行对比,以供临床参考。方法:回顾性分析带锁髓内针和旋入髓内针治疗的股骨干骨折患者60例,男49例,女11例;年龄12～68岁,平均33.5岁;其中稳定型骨折(股骨干狭窄段以上的横断、短斜或短螺旋骨折)41例,不稳定型骨折(狭窄段破坏粉碎大于直径50%的长斜及螺旋骨折、髓腔扩大的中下1/3骨折、多段骨折等)19例;均为新鲜骨折,不合并重要神经血管损伤。手术时间为伤后2h～7d。采用上述两种髓内针进行内固定。带锁髓内针治疗组患者术后即刻开始邻近关节功能活动,4～5d后开始患肢10～15kg的部分负重。旋入髓内针治疗组切口愈合后开始关节活动,6周后开始部分负重功能练习。然后,分别就其生物力学特点、手术操作、术后并发症、骨折愈合时间、患肢功能恢复以及手术适应证等方面进行分析、比较。结果:平均随访13个月,带锁髓内针组:闭和性骨折平均骨性愈合时间为16周,开放性骨折平均骨性愈合时间为20周。愈合率100%,畸形愈合率为7.9%。下肢功能恢复优27例,良1例,中1例,差1例,优良率93.3%。旋入髓内针组:闭和性骨折平均骨性愈合时间为16周,开放性骨折平均骨性愈合时间为23周。愈合率87%,畸形愈合率为18.2%。下肢功能恢复优23例,良2例,中3例,差2例,优良率83.3%。两组术后均未见金属断裂和骨不连现象。两组疗效在骨折愈合时间、畸形愈合率、再次手术率及术后功能恢复优良率等项指标差异明显。结论:带锁髓内针与旋入髓内针相比较对不同类型不同部位的股骨干骨折更具有可靠性、可操作性,并且可以降低主要并发症的发生率。旋入髓内针在其适应证内有较好疗效。

Objective ： To compare the clinical effect of rotary self-locking intramedullary nail （RSIN） and intramedullary interlocking hall （IIN） for the treatment of fresh femoral shaft fracture. Methods ：The radiological records of 60 fresh femoral shaft fractures （41 stable fractures and 19 unstable fractures） were retrospectively analyzed. Among them,49 were male and 11 were female. The average age was 33.5 years old（range from 12 to 68 years old）. All cases were fresh fracture with no important blood vessel or nerve injury,which were taken operation with RSIN on tIN respectively in 2 h-7 d after injury. The patients in IIN group began functional movements at postoperative 4 to 5 clays and could bear the weight of 10-15 kg. The patients in RSIN group could began functional exercises ＇after the wound healed and bear partly weight after 6 weeks. Both groups were contrasted on the biomeehanics,operation procedure,fracture healing time,functional recovery and operative indication. Results：Both groups were followed-up for average 13 months. IIN group：the average healing time of closed femur fracture was 16 weeks while that of open fracture was 20 weeks. The healing rate was 100% and the malunion rate was 7.9%. The excellent and good rate of functional recovery was 93.3% including excellent in 27 cases, good in 1, fair in 1 and bad in 1. RSIN group： the average healing time of closed femur fracture was 16 weeks while open fracture was 23 weeks. The healing rate was 87% and the malunion rate was 18.2%. The excellent and good rate of functional recovery was 83.3% including excellent in 23 cases,good in 2,fair in 3 and bad in 2. No implant break and nonunion happened. The differences between two groups in healing time,deformity-union rate and the rate of the twice operation were statistically significant. Conclusion：IIN provides a reliable and practical alternative method for the treatment of all kinds of femoral shaft fracture and its important complication is fewer than RSIN group. RSIN also has a good curative effect in its own indication.