闭合复位髓内扩张自锁钉治疗股骨干骨折

Closed reduction and intramedullary expanded self locking nail for the treatment of femoral shaft fracture

目的 观察髓内扩张自锁钉 (IESN)闭合复位治疗股骨干骨折的临床应用和疗效。方法本组股骨干骨折 2 5例。其中男 2 0例 ,女 5例。全部为新鲜闭合骨折。骨折类型横型与短斜型 12例 ,螺旋型 6例 ,粉碎型 7例。上 1/ 3骨折 8例 ,中 1/ 3骨折 10例 ,下 1/ 3骨折 7例。 2 2例采用牵引闭合复位置钉内固定 ,3例严重粉碎骨折采用小切口复位。结果 经 4～ 2 2个月 (平均 13个月 )随访 ,骨折全部愈合 ,愈合时间平均 4个月。按Klemm功能恢复分级标准 ,2 4例优 ,1例良。结论 (1)闭合复位内固定既保留了骨折端血肿 ,又保护了骨外膜血运 ,有利于骨折愈合。 (2 ) 80 %病例不用扩髓 ,对局部血运破坏小 ,有利于骨折愈合。 (3)扩大了髓内固定治疗股骨干骨折的适应症 ,术中出血少 ,创伤小。 (4)术后膝关节功能良好 ,避免第二次松解手术。

Objective To observe the results of patients with femoral shaft fractures treated with closed reduction and intramedullary expanded self locking nail (IESN) internal fixation Methods 25 patients,20 male and 5 female with femoral shaft fractures were treated operatively using IESN internal fixation.All of them were fresh closed fractures.Transverse and short oblique fractures were found in 12 spiral fractures in 6,comminuted fractures in 7;8 of the fractures were in the proximal middle third of the femur,10 in middle and distal middle third and 7 in the distal third.Closed reduction and IESN internal fixation had been adopted in 22 cases,3 comminuted fractures were reduced through a small incision.Results The follow up ranged from 4～22 months (average 13 months) All of the fractures healed up.The average fracture healing time was 14 months.According to Klemm evaluation method,24 patients were classified as excellent,1 as good.Conclusion Closed reduction internal fixation can protect the clotting blood around the fracture,the periosteal blood supply,and improve the fractures healing.IESN made the intramedullary fixation possible to be used widely in femoral fractures.