轴向控制动力性带锁髓内钉与普通带锁髓内钉置入治疗股骨骨折的比较

Axial controlled dynamic locked intramedullary nail versus static fixation in treatment of femoral fractures

目的:观察轴向控制动力性带锁髓内钉与普通带锁髓内钉置入治疗股骨骨折的临床疗效差异。方法:选择2003-10/2008-02东莞市常平医院外一科应用带锁髓内钉治疗股骨骨折且随访等资料齐全的病例,共58例患者60处骨折,男36例,女22例。轴向控制动力性带锁髓内钉与普通带锁髓内钉由天津正天医疗器械有限公司提供。58例患者60处骨折随机分为动力固定组(n=26)和静力固定组(n=34),将合适长度、直径的髓内钉置入髓腔至股骨下端离关节面4～6cm处,使用定位器在髓内钉远端分别置入2枚锁钉,静力固定组在普通股骨交锁髓内钉近端2个锁钉孔分别置入2枚锁钉;而动力固定组在轴向控制动力性带锁髓内钉近端只用1枚锁钉置入动力性锁钉孔。结果:全部患者均获得随访,切口均Ⅰ期愈合,无切口感染等并发症。静力固定组置入时间平均2.5h,愈合时间平均16周;延迟愈合7例,不愈合2例。动力固定组手术时间平均2.1h,愈合时间平均15周;延迟愈合3例,无不愈合。两组置入时间、骨折愈合时间相比,差异均无显著性意义(P>0.05);但两组骨折延迟愈合和不愈合发生率有显著差异(P<0.05),动力组(3/26)明显优于静力组(11/34)。结论:轴向控制动力性带锁髓内钉置入治疗股骨骨折较普通带锁髓内钉在避免应力遮挡、集中,增加骨折断端有益应力刺激方面有着一定优势。

AIM： To evaluate the effects of axial controlled dynamic locked intramedullary nail versus static fixation in treatment of femoral fractures. METHODS： From October 2003 to February 2008, 58 cases of 60 femoral fractures were treated with locking intramedullary nail fixation in First Department of Orthopaedics, Changping Hospital, including 22 females and 36 males. Axial controlled dynamic locked intramedullary nail and traditional locking intramedullary nail were provided by Tianjin Zhengtai. The intramedullary nail was implanted at 4-6 cm to articular surface from medullary cavity to inferior femur. Twenty-six femoral fractures were treated by two axial controlled dynamic locked intramedullary nails. The others were treated by one locked nail with static fixation mode. RESULTS： During the follow-up, the incision was recovered at stage Ⅰ with no injection or other complications. In the static interlocking fixation group, the mean implantation duration was 2.5 hours, and healing time was 16 weeks; there were delayed union in 7 cases and nonunion in 2 cases. In the axial controlled dynamic locked intramedullary group, the mean implantation duration was 2.1 hours, and healing time was 15 weeks; there were delayed union in 3 cases, and the other healed primarily. There were differences in terms of implantation duration and healing time （P 〉 0.05）, but the axial controlled dynamic locked intramedullary nail group （3/26） was superior over the static interlocking fixation group （11/34, P 〈 0.05）. CONCLUSION： Axial controlled dynamic locked intramedullary nail can be considered as an effective treatment for femoral fractures with beneficial stress stimulation in the fracture site, low stress shielding and concentration effect.