自制交锁髓内钉固定锁骨中段骨折的解剖学研究

Anatomical study on self-made intramedullary nails for fixation of clavicular fractures

目的根据锁骨的解剖学特点，研制一种交锁髓内钉固定锁骨中段骨折，并探讨其优缺点。方法通过对60根成人锁骨及5具成人新鲜尸体标本的测量、实验，测量锁骨长度、外侧段与中段夹角、中段与内侧段夹角、锁骨最窄处直径、锁骨最窄处髓腔内径等数据。设计出交锁髓内钉，其两端结构相同，均可与瞄准器相连接，采用逆行穿钉及两端锁定的方法固定锁骨中段骨折。结果锁骨全长为（14．82±1．15）cm，外侧段与中段夹角、中段与内侧段夹角均为30°左右，锁骨最窄处直径为（1．00±0．16）cm，锁骨最窄处髓腔内径为（0．50±0．18）cm。由锁骨中段骨折端逆行穿导针并扩髓，根据锁骨的形状适度折弯髓内钉，由近端或远端插入髓腔，分别用瞄准器锁定远、近端，固定稳定可靠。结论采用自制交锁髓内钉固定锁骨中段骨折手术创伤小，直视下复位满意而且固定可靠。但相关生物力学数据还有待于进一步研究。

Objective To design an intramedullary nail that had the same ends and could be connected to hairline pointer and employ it to fixate mid-shaft clavicular fractures. Methods Sixty a- dult clavicles and five fresh adult eadaveric clavicles were employed to measure full length, angle between lateral and middle segments, angle between middle and medial segments as well as the narrowest outer and inner diameters of the clavicle. The interlocked intramedullary nail with the same structure of two ends was designed and used to fixate mid-shaft clavicular fractures. The nail was inserted in retrograde manner and locking screws could be inserted at both ends. Results The full length, angle between lat- eral and middle segments, angle between middle and medial segments as well as the narrowest outer and inner diameters of the clavicle were （ 14.82 ± 1.15 ） cm, 30°, 30°, （ 1.00 ± 0. 16 ） cm and （0.50 ± 0. 18） cm respectively. After conversely placing guide pin from the fracture end, expanding medullary cavity and adjusting the nail, the designed nail was inserted into the medullary cavity from the distal or proximal ends of the clavicle, which was locked by interlocked screws. Conclusions Self-made nail takes advantages of less surgical invasion, visible fracture reduction and stable fracture fixation for treat- ment of mid-shaft clavicular fractures. While the biomechanical properties of the nail need further investi- gation.