可膨脹髓內釘在肱骨干骨折中的療效分析

[摘要] 目的 探討可膨脹髓內釘在肱骨干骨折中的應用方法和療效。 方法 整群選取2012年10月—2014年3月該院采用可膨脹髓內釘閉合復位內固定術治療肱骨干骨折64例，其中男37例，女27例；年齡21～81歲，平均47歲。均為新鮮骨折，骨折按AO分型，A型43例，B型21例，C型0例。 結果 該組病人全部獲得隨訪，術中平均出血74 mL，平均手術用時93 min；64例骨折全部愈合，平均愈合時間為12.6周；64例患者根據Neer肩關節功能評分系統，肩關節功能優41例，良17例，可6例，差0例，優良率為90.6%；所有病例均未發生術中橈神經損傷、肱動脈損傷并發癥。 結論 可膨脹髓內釘治療肱骨干骨折，具有操作方便、骨折愈合率高、橈神經損傷發生率高等優點，是一種較為理想的治療方法。

[關鍵詞] 可膨脹髓內釘；肱骨干骨折；內固定

[中圖分類號] R687 [文獻標識碼] A [文章編號] 1674-0742（2016）10（b）-0025-03

[Abstract] Objective To analyze the effectiveness and surgical technique of expandable intramedullary nail system（EINS） in the treatment of humeral shaft fracture. Methods Group selection from October 2012 to March 2014， 64 patients of humeral shaft fracture were treated by closed reduction and internal fixation with EINS. There were 37 males and 27 femals with a mean age of 47 years（range 17～63 years）. All of the cases were fresh fractures. According to AO classification of humeral shaft fracture， there were 43 cases of type A， 21 of type B， and 0 of type C. Results All the patients were followed up. The averaged blood loss was 74ml and the averaged time of surgery was 93 min. All of the 64 cases got fracture healing and the time for fracture union was 12.6 weeks in average. 64 cases were assessed according to Neer shoulder function score system， 41 cases were excellent， 17 good， 6 fair， 0 poor. The rate of excellent and good was 90.6%. There was no patient who was complicated with injury of radial nerve or brachial artery during surgery. Conclusion Treatment of humeral shaft fracture with EINS is a effective method， with the advantage of convenient manipulation， high ratio of fracture healing， and less possibility of radial nerve injury.

[Key words] Expandable intramedullary nail； Humeral shaft fracture； Internal fixation

肱骨干骨折是指肱骨外科頸下方2 cm至肱骨髁上2 cm之間的部位發生的骨折，約占全身骨折的1.3%。大部分的肱骨干骨折是由直接撞擊、高處墜落等直接暴力所致，小部分是由肘部以下傳導而來的間接暴力所致。肱骨干骨折的治療分為保守治療及手術治療。保守治療包括手法復位小夾板固定、懸垂石膏固定等，適用于穩定的骨折類型或有手術禁忌證的患者；而對于不穩定的肱骨干骨折常采取手術治療，手術方法包括切開復位鋼板內固定、交鎖髓內釘內固定、外固定架固定等。該院自2012年10月—2014年3月，采用FIXION可膨脹髓內釘行閉合復位內固定術治療肱骨干骨折64例，療效滿意，現報道如下。……