带锁髓内钉治疗下肢长骨复杂骨折及骨折不连

Clinical use of Interlocking intramedullary nail treating in complex and nonunion fracture of femur and tibia

目的 :应用带锁髓内钉治疗下肢长骨复杂骨折及长骨不连并观察其疗效。方法 :对 1998年 2月～ 2 0 0 0年 7月的 48例 5 1处复杂骨折及骨折不连应用带锁髓内钉进行回顾性分析和探讨。结果 :随访时间 6～ 2 9个月 ,46例 49处骨折愈合 ,愈合率 95 .8% ,骨折愈合时间分别为 :股骨新鲜骨折 16周 (10～ 2 4周 ) ,骨折不连 2 0周 (14～ 46周 ) ;胫骨新鲜骨折 18周 (12～ 2 8周 ) ,骨折不连 2 4周 (16～ 32周 )。功能评价 :股骨骨折的优良率 95 .2 % ,差 4.8% ,胫骨骨折的优良率10 0 %。并发症 8例 ,发生率 16 .6 7% ,其中远端锁钉打偏 3例 ,骨质劈裂 1例 ,肢体短偏 1例 ,锁钉松动 2例 ,骨折不连 1例。结论 :带锁髓内钉可用于下肢长骨各种类型的骨折 ,尤其适用于复杂骨折及原内固定失败的骨折不连。

Fifty one complex and nonunion fractures of femur and tibia in forty eight patients were treated with interlocking intramedullary nail. All patients were followed up for 6 to 29 months to evaluate the curative effect. Forty nine fractures in forty six patients were healed(95.8%). The time of healing was 16 weeks(10～24weeks) in femur and 18 weeks (12～28week) in tibia in fresh fracture, and 20 weeks(14～46weeks) in femur nonunion and 18 weeks (12～28 weeks) in tibia nonunion. In femur, the efficacy of 28 cases was excellent or good (93.3%), and 2 cases mediate (6.7%); in tibia, 18 cases were all assessed as excellent or good. The complications were observed in 8 patients (16.67%), including distal screw misinserting, extremity shortening, screw loosening, distal shaft fracture and fracture nonunion. The results suggest that interlocking intramedullary nail can be used in many kinds of femur and tibia fracture with satisfactory result, especially in the complex fracture and nonunion after fixation failure.