可膨胀髓内钉在肱骨干骨折中疗效探析.doc

可膨胀髓内钉在肱骨干骨折中的疗效分析 　　[摘要] 目的 探讨可膨胀髓内钉在肱骨干骨折中的应用方法和疗效。 方法 整群选取2012年10月―2014年3月该院采用可膨胀髓内钉闭合复位内固定术治疗肱骨干骨折64例，其中男37例，女27例；年龄21～81岁，平均47岁。均为新鲜骨折，骨折按AO分型，A型43例，B型21例，C型0例。 结果 该组病人全部获得随访，术中平均出血74 mL，平均手术用时93 min；64例骨折全部愈合，平均愈合时间为12.6周；64例患者根据Neer肩关节功能评分系统，肩关节功能优41例，良17例，可6例，差0例，优良率为90.6%；所有病例均未发生术中桡神经损伤、肱动脉损伤并发症。 结论 可膨胀髓内钉治疗肱骨干骨折，具有操作方便、骨折愈合率高、桡神经损伤发生率高等优点，是一种较为理想的治疗方法 [关键词] 可膨胀髓内钉；肱骨干骨折；内固定 [中图分类号] R687 [文献标识码] A [文章编号] 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颈下方2 cm至肱骨髁上2 cm之间的部位发生的骨折，约占全身骨折的1.3%。大部分的肱骨干骨折是由直接撞击、高处坠落等直接暴力所致，小部分是由肘部以下传导而来的间接暴力所致。肱骨干骨折的治疗分为保守治疗及手术治疗。保守治疗包括手法复位小夹板固定、悬垂石膏固定等，适用于稳定的骨折类型或有手术禁忌证的患者；而对于不稳定的肱骨干骨折常采取手术治疗，手术方法包括切开复