尺、桡骨交锁髓内钉的设计与临床应用

The design and clinical application of interlocking intramedullary nails in treatment of forearm fractures

目的探讨尺、桡骨交锁髓内钉固定系统的临床应用效果。方法尺、桡骨髓内钉系截面为圆形的实心直金属棒，其直径可分为3．5mm、4．0mm、4．5mm和5mm等规格，锁孔直径为2．7mm；配有扩髓器和瞄准器。2001年8月至2005年7月，采用交锁髓内钉治疗尺、桡骨骨折、骨不连患者31例，男26例，女5例；年龄20-72岁，平均4012岁。单纯尺骨骨折6例，单纯桡骨骨折6例，孟氏骨折5例，盖氏骨折1例，尺、桡骨双骨折10例，尺骨骨折术后骨不连3例。结果31例均获随访，随访时间2-6年，平均4．3年。根据Hertel前臂骨折愈合分类，28例骨折愈合（包括3例骨不连患者），愈合时间10-17周，平均14．2周；2例骨折延迟愈合；1例骨不连。根据Anderson等前臂骨折功能评价标准：26例为优，2例为满意，2例为不满意；1例为失败（术后6个月桡骨骨不连，予加压钢板内固定和植骨治疗，骨折愈合）。尺、桡骨交叉愈合1例，桡神经浅、深支损伤各1例，无髓内钉松动、断裂及切口感染。27例取出内固定，未发生再骨折；4例因患者原因内固定未取出。结论尺、桡骨交锁髓内钉固定可用于治疗单纯尺骨或桡骨干骨折、尺、桡骨双骨折、骨不连等前臂骨折，具有创伤小、恢复期短、再骨折率低等优点。

Objective To design a kind of forearm interlocking intramedullary nail and investigate the clinical effect. Methods A kind of forearm interlocking intramedullary nails was designed as straight, solid circle nails, with 2.7 tam diameters locking holes, four types as the diameter in 3.5mm, 4.0 mm, 4.5 mm and 5 mm. And the system accompanied by reamers and aiming fixation. From August 2001 to July 2005, 31 cases of forearm fractures or nonunion were treated by forearm interlocking intramedullary nails, including 26 males and 5 females with an average age of 40.2 years （range, 20-72 years）. There were single ulnar fractures for 6 cases, single radial fractures for 6, Monteggia fractures for 5, Galeazzi fractures for 1, 10 cases for both forearm bones fractures, and 3 cases for nonunion after surgery for ulnar fractures. And 26 cases were fresh fractures, 2 cases were old fractures. Results All the 31 cases were followed up for 2-6 years with an average of 4.3 years. Twenty-eight cases obtained solid union. Based on the Hertel classification of forearm fractures union, the average time to fracture healing was 14.2 weeks （range, 10-17 weeks）. Two cases got delayed union, 1 got nonunion. One case got cross union, 1 got superficial radial nerve injured, 1 got deep radial nerve injured. There was no losing or breaking of the nail, no infection of the wound. The fixations of 27 cases had been removed, none of them got refractures. According to the Anderson standard, 26 patients had excellent results, 2 cases had satisfactory results, 2 cases had unsatisfactory results, and one patient had a failed result. Conclusion Forearm interlocking intramedullary nail has the advantages such as less injury, recovering rapidly, fewer refractures, and so on, to treat single ulnar or radial fractures, both forearm bone fractures, and nonunion.