可膨胀髓内钉在四肢长骨骨折治疗中的应用体会

Use of Expandable Intramedullary Nail System in the Treatment of Limb Fractures

目的探讨可膨胀髓内钉在四肢骨折治疗中的临床疗效及经验体会。方法自2006年6月至2008年6月对31例骨折病人应用可膨胀髓内钉治疗,共32钉,男20例,女11例,年龄19～85岁。股骨干骨折9例,胫腓骨骨折4例(双胫骨骨折1例,开放性骨折1例),肱骨骨折6例,股骨近端骨折12例。结果伤口全部1期愈合,手术时间45～150 min,平均97.5 min。单侧肢体出血50～500 mL,平均275 mL。31例患者全部获得随访,随访时间8周～32周,平均20周。骨折愈合时间:股骨近端6～14周,股骨干11～15周,胫骨干10～14.8周,肱骨干12～15周。结论可膨胀髓内钉因其设计特点,使其在四肢骨折的治疗中具有诸多优点:手术操作简便,创伤小,缩短了手术时间;X线下的暴露时间大大减少,可同时减少医患的放射损害,尤其适用于未育的年轻患者;轴向弹性固定,加快骨折愈合;FIXION PF型膨胀栓钉挤压松质骨,不存在内固定对骨质的切割,对骨质疏松患者尤其适用;无需远端锁定,故肢体远端皮肤条件差的患者同样适用,为长骨骨折的治疗提供了一种崭新的思路。

Objective To investigate and assess the effectiveness and methods of using expandable intramedullary nail system（EINS） in the clinical treatment of limb fractures. Methods From June,2006 to June,2008,a total of 31 cases with limb fracture were treated with EINS.In total,32 nails were used for 20 male patients and 11 female patients,ranging from ages of 19 to 85;femur,9 cases;tibiofibular,4 cases（both tibiofibular,1 case;compound fracture,1 case）;humerus,6 cases;proximal femur,12 cases. Results In all 31 cases,the wounds healed within the first stage,time of surgery ranged from 45 to 150 minutes,averaging 97.5 minutes per surgery.Single side limb blood lose ranged from 50 to 500 mL,on average,275 mL.Thirty-one patients were followed up post surgically.Follow-up periods ranged from 8 to 32 weeks,averaging 20 weeks.The average healing time of treated limb fractures： 10 weeks for proximal femur,12.8 weeks for femur,12.4 weeks for tibiofibular,13.5 weeks for humerus. Conclusion EINS has a unique design that is advantageous in the clinical treatment of limb fractures.Its surgical procedures are relatively simple,less invasive,and the duration of surgery short.In addition,EINS significantly decreases the amount of X-ray exposure,thus,decreasing the potentially harmful effects of X-ray on both doctors and patients,especially for young patients that have not had children.The axial flexibility is stable and accelerates the healing of fracture.PF expandable stud extrudes cancellous bone and does not pose the problem of bone cutting used in internal bone fixation methods.This is especially suitable for osteoporotic patients.There is no need for remote locking and is therefore suitable for both distal limb patients and patients with skin conditions.EINS provides an innovative alternative method for the treatment of long bone fracture.