摘要
目的总结在无空心髓腔软钻的情况下采用闭合复位交锁髓内钉内固定术治疗股骨干骨折的方法及优点。方法2006年1月-2007年6月,收治24例股骨干闭合骨折患者。男14例,女10例;年龄18～63岁,平均38.3岁。左侧7例,右侧17例。病程3～20 d,平均7.6 d。AO分型:A型5例,B型6例,C1型7例,C2型2例,C3型4例。术中对断端均不予切开,透视指导下闭合复位,顺行扩髓并植入髓内钉。结果手术时间100～170 min,平均128.3 min;1例输血400 mL,余患者均未输血。20例获随访6～24个月,平均13.1个月。术后6～12周X线片可见大量骨痂生长。术后15～30周,平均22.2周去拐行走。伸膝均达0°;屈膝120～170°,平均145.5°。无感染及内固定物断裂。术后出现骨化性肌炎伴屈髋受限、疼痛1例,口服非甾体类消炎镇痛药后症状消失;无症状骨化性肌炎2例,未行特殊处理。结论闭合复位交锁髓内钉内固定治疗股骨干骨折具有保护断端血供、中心固定、固定强度高等优点;在无空心髓腔软钻情况下,需要特殊的手术操作程序。
Objective To discuss the techniques and advantages of closed reduction and intramedullary nailing in treating femoral shaft fracture without cannulated femoral reamer. Methods From January 2006 to June 2007, 24 cases of femoral shaft fracture were treated with closed reduction and intramedullary nailing. Among them, there were 14 males and 10 females, with the average age of 38.3 years （ranging from 18 years to 63 years）, with 7 left legs and 17 right legs. The average course of the disease was 7.6 days （ranging from 3 days to 20 days）. According to the AO typing, there were 5 cases of type A, 6 of type B, 7 of type C1, 2 of type C2 and 4 of type C3. Closed reduction was achieved with manipulation and reaming of femoral canal was instructed by fluoroscopy. Results The operation time lasted from 100 minutes to 170 minutes, with the average time of 128.3 minutes. One patient was given a transfusion of 400 mL, and others were not. Twenty cases were followed up with the average time of 13.1 months （ranging from 6 months to 24 months）. A mild to large amount of bony callus was showed on X-ray films 6 to 12 weeks postoperatively. Walking without crutches began at the average week of 22.2 （ranging from 15 to 30） postoperatively. Range of motion of the knee was 0° to 145.5°. No infection or break of the internal fixator occurred. Myositis ossificans with pain and insufficient flexion of hip （120°） happened in 1 case and the pain disappeared after non-sterold anti-inflammatory drugs were taken. Nonsymptomatic myositis ossificans occurred in 2 cases and no treatment was needed. Conclusion Closed reduction and intramedullary naillng can help to protect the blood supply of fracture fragments and provide central fixation. The operation process will be more complicated if cannulated femoral reamer is not available.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2008年第6期700-702,共3页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
股骨干骨折
闭合复位
交锁髓内钉
Femoral shaft fracture Closed reduction Intramedullary nailing
