闭合复位交锁髓内钉固定治疗股骨干骨折

Interlocking intramedullary nails and closed reduction in treatment of fracture of shaft of femur

目的探讨应用闭合复位交锁髓内钉固定治疗股骨干骨折的临床效果。方法回顾性分析2007年2月至2008年1月应用闭合复位交锁髓内钉内固定技术治疗股骨干骨折患者123例,男94例,女29例;年龄24～54岁,平均39岁;开放性骨折27例,闭合性骨折96例。根据AO分型:A型46例,B型38例,C型39例。结果 A型骨折手术时间45～62 min,平均53 min;B型骨折手术时间49～68 min,平均59 min;C型骨折手术时间48～82min,平均67 min。3例股骨近端内侧皮质粉碎骨折或骨折向内成角,其中1例髋内翻;4例骨折远端出现劈裂;1例膝关节外翻;5例术锁钉断裂或退出;1例主钉断裂;8例出现不同程度的神经牵拉伤。无一例出现深静脉血栓、肺栓塞和感染并发症。其中112例获得随访,随访时间为12～20个月,平均16个月。A型和B型骨折78例中39例行静力改动力化锁钉,骨折平均愈合时间为6个月;另39例行持续静力化锁钉,骨折平均愈合时间为8个月。C型骨折平均愈合时间为12个月。无一例患者出现骨折不愈合。术后患者髋膝关节功能优良率为98%。结论闭合复位交锁髓内钉内固定术是治疗股骨干骨折的有效方法之一。

Objective To evaluate the clinical effects of interlocking intramedullary nails and closed reduction in treatment of fractures of shaft of femur.Methods From February 2007 to January 2008,123 patients with femoral fractures were treated by placement of interlocking intramedullary nails and closed reduction.There were 94 males and 29 females with an average age of 39 years（range,24-54 years）.Of them,27 cases were open fracture,96 cases were closed fracture.According to AO typing,type A in 46 cases,type B in 38,and type C in 39.Results The average surgical time for type A,type B and type C fractures were 53（range,45-62）,59（range,49-68）and 67（range, 48-82）min,respectively.Fracture of proximal segment of femur in 3 cases,fracture of distal segment of femur in 4 cases, interlocking nail broke in 5 cases,and intramedullary nail broke in 1 case.Eight cases had nerve tension injuries of different degrees.No embolism in lung and deep veins and infections occurred in this group.In the patients of type A and B fractures who transferred static locking into dynamic locking,the average time of bone healing was 6 months;and in the patients who continued static locking,the average healing time was 8 months.The average healing time of type C fracture was 12 months,and there was no infection and nonunion of fracture.The recovery rate of limb and joint function was 98%.Conclusion Interlocking intramedullary nail and closed reduction is an effective way to treat the femoral fracture.