交锁髓内钉治疗肱骨干骨折后骨不愈合原因分析

Analysis of postoperative nonunion after treatment of humeral shaft fracture with interlocking intramedullary nails

背景:作为治疗肱骨干骨折的一种选择,髓内钉并没有降低骨折不愈合的风险。现有临床资料的研究有助于推测其发生的原因。目的:探讨交锁髓内钉治疗肱骨干骨折后骨不愈合的原因。方法:回顾分析2005年1月至2010年1月行交锁髓内钉固定治疗的52例肱骨干骨折患者。观察术后骨折愈合情况,分析术后骨折不愈合的原因,探讨防治方法。运用Rodriquez-Merchan评分评价功能恢复情况。结果:52例患者获得平均15个月(12～20个月)随访。47例患者骨折愈合(其中延迟愈合5例),愈合时间3～6个月,平均4.1个月。5例患者骨折不愈合,均为肱骨干中下段骨折,4例二次手术治疗,1例保守治疗。Rodriquez-Merchan评分:优33例,良12例,中2例,差5例,优良率86.6%。结论:交锁髓内钉固定肱骨干骨折术后发生的骨折不愈合,与损伤情况、手术操作、感染的控制、患者术后配合情况等多种因素相关。

Background： As a choice for operatively treated humeral shaft fractures, intramedullary nail do not reduce the risk of nonunion. A analyze of existing clinical information would improve inferences regarding the reason. Objective： To analyze causes for postoperative nonunion after treatment of humeral shaft fracture with interlocking intramedullary nails. Methods： A retrospective study was done on 52 patients with humeral shaft fracture treated with interlocking intramedullary nails from January 2005 to January 2010. The postoperative healing was observed and the causes for postoperative nonunion were analyzed. Exploring prevention and treatment. Rodriquez-Merchan score was used to evaluate the function recovery. Results： Of all, 52 patients were followed up for 12 - 20 months （ mean 15 months） . 47 patients fracture were healing （ Delayed union in 5 patients）, the average fracture healing time was 4. 1 months （3 -6 months）. Nonunion occurred in 5 patients, all of them were fractures below the humeral shaft, four of whom treatmented in the second surgery and the other received conservative treatment. According to Rodriquez-Merchan evaluation system, the rates of excellent and good were 86. 6%. Conclusions： Treatment of humeral shaft fracture with interlocking intramedullary nails, many factors including injury, operation, eontroling infection, postoperative patient＇s cognitive condition may affect postoperative nonunion.