肱骨交锁髓内钉治疗肱骨干骨折不愈合

Treatment of Nonunion of the Humeral Shaft Fracture with Interlocking Intramedullary Nailing

目的探讨交锁髓内钉在治疗肱骨骨折不愈合中的应用和临床效果。方法对21例肱骨干骨折经治疗后不愈合(钢板内固定16例,外固定架固定2例,保守治疗3例)病例进行了原内固定取出、交锁髓内钉固定及自体髂骨植骨手术,21例中原发桡神经损伤11例。结果手术时间95～180min(平均135min),术中出血量260～580mL(平均380mL),术中出现1例医源性桡神经损伤,经保守治疗2个月后恢复。未发生其他血管损伤、髓腔感染、断钉及血栓形成等并发症。随访7～24个月,21例中19例在术后12～20周内愈合。2例出现延迟愈合,经进一步保守治疗分别在术后25周和33周愈合,此2例均为原发桡神经损伤较重者。肩关节功能按Neer评分,优17例,良3例,一般1例。结论交锁髓内钉固定同时行自体髂骨植骨治疗肱骨干骨折不愈合具有疗效好、并发症少及取内固定手术简单等优点,是一种较理想的治疗方法。

Objective To analysis the technique and clinical results of interlocking intramedullary nails for nonunion of humeral shaft fracture. Methods Between September 2004 and November 2007, 21 patients with nonunion of humeral shaft fracture （16 cases were operated with plates, 2 cases were fixed with external fixation clamp,3 cases were treated closed）were treated with interlocking intramedullary nails and autologous bone grafting. There were 11 cases with the radial nerve injury in 21 patients. Results The surgical time ranged from 95-180 mins （135 mins in average）and bleeding from 260- 580 mL （380 mL in average）. One radial nerve injuries cases occurred intraoperatively and healed after 2 months. No vessel injuries ,deep infection,breakage of nail and blood blot was noted. All cases were followed up, 19 cases fracture union need 12-20 weeks,2 cases fracture delay-union and need separately 25 and 33 weeks. The function of shoulder and elbow were based on Neer grade standard： 17 cases were excellent,3 cases were good and 1 cases was fair. Conclusion The advantage of using interlocking intramedullary nails for nonunion of humeral shaft fracture were less syndromes, higher union rate and simple second operation. It is one of the effective methods in curing the nonunion of humeral shaft fracture.