应用前臂带锁髓内钉治疗尺桡骨骨折初步疗效分析

Intramedullary nails in treatment of forearm fractures

目的探讨髓内钉固定系统治疗尺、桡骨骨折的临床疗效。方法自2003年10月至2007年3月收治并获得随访的尺、桡骨骨折患者共94例，其中尺骨骨折35例，桡骨骨折38例，尺、桡骨双骨折21例，均为闭合性骨折。所有患者均采用闭合复位或小切口有限切开复位髓内钉内固定术，术前若伴有上、下尺桡关节脱位的病例则行石膏单托前臂旋后位固定3周，否则术后早期功能锻炼。结果所有患者随访9～26个月，平均13．5个月，术后骨折全部愈合，愈合时间8-14周，平均10．2周。并发症：术中骨质劈裂2例，桡神经浅支挫伤1例，骨桥连接1例，无血管、肌腱损伤、骨髓炎、不愈合、内固定失败病例，并发症发生率4．2％。术后半年Anderson功能评价：优68例，良22例，可4例，总优良率95．7％。肘关节屈伸丧失0～15°，平均5．5°，前臂旋前丧失0～35°，平均14．2°，旋后丧失0～50°，平均18°。结论髓内钉用于尺、桡骨骨折的治疗有其独特的优势，特别是对于骨质疏松、多段、粉碎骨折，具有疗效满意、创伤小、并发症少的特点，但在临床应用中需要掌握一定的熟练技术及指征。

Objective To study the clinical effects of interlocking intramedullary nails in the management of forearm fractures. Methods From October 2003 to March 2007, 94 cases of closed forearm fractures were treated with intramedullary nailing after closed or limited open reduction. Of them, 35 cases were diagnosed as ulnar fracture, 38 radial fracture, and 21 both ulnar and radial fracture. Plaster fixation of forearm supinated for 3 weeks was applied for patients complicated with dislocation of distal and proximal radioulnar joints, and early rehabilitation was encouraged for other patients. Results All the cases were followed up for an average period of 13.5 （9 to 26） months. All obtained bone union, with the healing duration averaged 10.2 （8 to 14） weeks. Six months after operation, by Anderson functional evaluation, 68 cases were rated as excellent, 22 as good, and 4 as fair. The good to excellent rate was 95.7%. The rate of complications was 4. 2%, with 2 cases of secondary fracture during the operation, 1 case of nerve injury, and 1 case of bony bridge synostosis. No injury to blood vessels or tendons, medullitis, disunion, internal fixation failure or refracture was found. Conclusions Interlocking intramedullary nails are an effective treatment for patients with forearm fractures, especially those with osteoporosis, multiple-fractures and comminuted fracture, characterized by few complications and limited invasion as well as requirement of skillful surgical techniques.