带锁髓内钉治疗下肢长骨复杂骨折及骨折不连

摘要

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～2000年7月的48例51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6～29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(10～24周)，骨折不连20周(14～46周)；胫骨新鲜骨折18周(12～28周)，骨折不连24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100%。并发症8例，发生率16.67%，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.