可膨胀髓内钉治疗肱骨干骨折的疗效及其影响因素分析

Effect of expandable intramedullary nail on humeral shaft fracture

目的：评价可膨胀髓内钉治疗肱骨干骨折的疗效，分析影响疗效的相关因素。方法：2011年1月～2012年12月对我院收治的145例肱骨干骨折患者，分别采用可膨胀髓内钉治疗52例，交锁髓内钉治疗50例，钢板固定治疗43例，观察并比较各术式切口长度、手术时间、失血量、骨折愈合率、手术透视时间、肩关节功能恢复以及并发症情况。结果：可膨胀髓内钉组与交锁髓内钉组在切口长度、失血量、骨折愈合率方面差异无统计学意义（P〉0．05），手术时间，手术透视时间差异有统计学意义（P〈0．05）；可膨胀髓内钉组与钢板组在切口长度、手术时间、失血量、骨折愈合率和并发症方面差异均有统计学意义（P均〈0．05）。结论：可膨胀髓内钉治疗肱骨干骨折，具有微创、并发症少，操作简单，固定牢靠，愈合率高等优点，是治疗非严重粉碎肱骨干骨折的较佳术式。术中骨折的复位质量、骨折类型及部位、置钉直径、长度与进钉部位及深度、术后正确的关节功能锻炼是影响患者术后疗效的主要因素。

Objective= To evaluate the clinical effect of the expandable intramedullary nail on trea- ting humeral shaft fracture. Methods.A total of 145 cases of humeral shaft fracture admitted from January 2011 to December 2012 were selected, including 52 cases treated by the expandable intramedullary nail, 50 with interlocking nail, and 43 cases with dynamic compression plate. Incision length, operation time, blood loss, fluoroscopy exposure, healing rate of fracture, function of should joint and complications were observed and compared. Results=The differences in incision length, blood loss, healing rate of fracture be- tween expandable intramedullary nail group and the interlocking nail group were not significant （P 〉0.05）. There was significant difference in operation time and fluoroscopy exposure between two groups（P 〈0.05）. There was significant difference in incision length, operation time, blood loss,healing rate of fracture and complications （P〈0.05）. Conclusion. The expandable intramedullary nail has advantages of minimal invasion, simple operation, fast fixation, less injury and high healing rate of fracture . It is better surgical option in treating nonserious comminuted humeral shaft fracture. The influential factors are re- duction of fracture during operation, fracture type, fracture site, diameter and length of the expandable intramedullary nail, site of entry point and postoperative functional exercise.