逆行带锁髓内钉治疗肱骨干中下段骨折的临床观察

Retrograde locked intramedullary nail for the treatment of middle or distal fractures of humeral shaft

目的:通过分析21例逆行带锁髓内钉治疗肱骨干中下段骨折的疗效,探讨治疗体会及教训。方法:2002年10月至2005年2月采用AO逆行带锁髓内钉治疗肱骨干中下段骨折21例,新鲜骨折19例,陈旧骨折2例;肱骨中段骨折10例,下段骨折11例;男13例,女8例;平均年龄34.5岁(23～56岁)。2例陈旧骨折均为不愈合,行自体植骨;5例伴桡神经损伤者行探查术。最终随访时应用Constant-Murley肩关节评分和Mayo肘关节评分评估治疗结果。结果:21例均获随访,平均时间20.8个月(18～24个月),除1例陈旧骨折和极远端骨折外全部愈合。肩、肘关节功能除1例陈旧骨折肘关节功能一般外均较满意。Constant-Murley肩关节评分平均(83.6±13.4)分(50～97分),优12例,良5例,一般4例,差0例;Mayo肘关节评分平均(88.6±9.8)分(65～95分),优13例,良5例,一般3例,差0例。结论:逆行带锁髓内钉是治疗肱骨中下段骨折较理想的方法,严格的手术适应证、精确的手术技术、稳定的锁定是手术成功的关键。

Objective：To study therapeutic effects of retrograde locked intramedullary nail for the treatment of middle or distal fractures of humeral shaft.Methods：From October 2002 to February 2005,21 patients with middle or distal fractures of humeral shaft were treated with AO retrograde locked intramedullary nail.Among the patients,13 patients were male and 8 patients were female,ranging in age from 23 to 56 years,with an average of 34.5 years.Nineteen patients were fresh fractures,and 2 patients were old fractures.Eleven patients had middle fractures of humeral shaft,and other 10 patients had distal fractures of humeral shaft.Two patients with old fractures were non union and treated with autoallergic bone grafting; 5 patients combined with radial nerve injury underwent exploration.The therapeutic effects were evaluated according to Constant-Murley shoulder score and Mayo elbow score.Results：All the patients were followed up,ranging from 18 to 24 months,with an average of 20.8 months.The fractures were healed except 1 patient with old fracture and 1 patient with extremly distal acute fracture.The shoulders and elbows had satisfactory recovery except 1 patient with old fracture.The mean Constant-Murley score was （83.6±13.4） points （50～97）,12 patients got an excellent result,5 good,4 fair and no bad; the mean Mayo elbow score was （88.6± 9.8）points （65～95）,13 patients got an excellent result,5 good,3 fair and no bad.Conclusion：The retrograde locked intramedullary nail offers an ideal treatment method for middle and distal fractures of humeral shaft.Strict operative indication, precise surgical techniques and stable locking are the keys to a successful treatment results.