| 交锁髓内钉在四肢长管状骨骨折中的失误与处理 |
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Received:June 15, 2005
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| 期刊信息：《中国骨伤》2006年19卷，第4期，第219-220页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
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目的:探讨交锁髓内钉技术的临床疗效及并发症的主要原因和治疗效果。
方法:1999年6月-2004年6月采用交锁髓内钉技术治疗四肢长管状骨骨折420例,男310例,女110例;其中股骨干骨折180例,胫腓骨双骨折160例,肱骨干骨折10例,股骨粗隆间骨折60例,股骨髁上骨折10例。年龄20~87岁,平均56岁。发生并发症30例,术中骨折端劈裂2例,钢丝捆扎后完成交锁;异位再骨折2例和术后再骨折2例,更换较长的髓内钉;髓内钉卡在髓腔内进退困难1例,捶击髓内钉尾端拔出髓腔;横向交锁失误12例,其中10例在术中发现退出锁钉重新完成交锁,2例在术后发现应用石膏外固定6周;术后发生主钉断裂2例,二次手术更换较粗的主钉;骨折端不稳定出现反常活动3例,应用石膏外固定6~8周;导针与钻头相嵌顿2例,通过捶击拔出钻头退出导针;腹壁软组织损伤4例进行理疗。
结果:本组400例得到6~12个月的随访,骨折全部愈合。膝关节屈曲受限（<90°）4例,肩关节外展上举受限（<90°）1例。
结论:交锁髓内钉技术治疗四肢长管状骨骨折临床疗效良好;粗劣的操作技术是发生并发症的主要原因;积极处理并发症可避免功能障碍的发生。 |
| [关键词]:四肢骨折 骨折固定术,髓内 并发症 |
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| Fault and management on the treatment of extremities fracture with intermedullary locking nails |
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Abstract:
Objective:To investigate the clinical effect of intermedullary locking nails in the treatment of extremities fracture and its main complication.
Methods:From June 1999 to June 2004,420 patients(male 310,female 110)with long tubular bone fracture were treated with intermedullary locking nails.The age was 20-87 years with an average of 56 years.Among them,fracture of femoral shaft was 180 cases,fracture of both tibia and fibula was 160 cases,fracture of humeral shaft was 10 cases,intertrochanteric fracture of femur was 60,supracondylar fracture of femur was 10.The operative failure and complication were found in 30 patients.The cleft of fracture end in 2 patients bounded with steel wire;dystopy and refracture during operation in 2 patients and refracture after operation in 2 patients changed with long nails;nail clenched in the medullary in 1 patient pull out with hammer;failure of cross-lock in 12 patients,and relocked during operation in 10 patients and fixed with plaster in 2 patients after operation;breakage of main nail in 2 patients changed with new nails;abnormal motion in 3 patients fixed with plaster for 6-8 weeks;locking of probe and drill in 2 patients pull out with hammer;abdominal soft tissues injury in 4 patients treated with physiotherapy.
Results:400 patients were followed up from 6 to 12 months,fracture healing was found in all patients.Limited flexion of knee joint in 4 patients (<90°);limited abduction of shoulder joint in 1 patient(<90°).
Conclusion:Clinical result is satisfactory in the treatment of long tubular bone fracture with intermedullary locking nails;inaccurate operation are main reason of complication and failure.Immediate treatment of complication can avoid functional disturbanc. |
| KEYWORDS:Extremities fracture Fracture fixation,intermedullary Complications |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张之栋,任启光.交锁髓内钉在四肢长管状骨骨折中的失误与处理[J].中国骨伤,2006,19(4):219~220 |
| 英文格式: | ZHANG Zhi-dong,Ren Qi-guang.Fault and management on the treatment of extremities fracture with intermedullary locking nails[J].zhongguo gu shang / China J Orthop Trauma ,2006,19(4):219~220 |
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