逆行交锁髓内钉治疗肱骨中下段骨折疗效观察(1)
摘 要：目的 评价应用闭合复位逆行交锁髓钉内固定治疗肱骨中下段骨折的临床效果，观察患者术后肩肘关节恢复情况。方法 分析我院2010年1月～2017年8月47例肱骨中下段骨折采用闭合复位逆行交锁髓钉内固定治疗患者，按AO骨折分型A型20例，B型15例，C型12例， 术后早期行肩肘关节功能锻炼。结果 45例患者获8～23 y(平均15 y)随访，骨折全部愈合，肩、肘关节功能良好。骨折临床愈合时间14 w，无切口感染、骨折不愈合及内固定断裂等并发症。结论 闭合复位逆行交锁髓钉内固定治疗肱骨中下段骨折具有手术操作简单、创伤小、手术时间短、出血少，不损伤肩袖，肩肘关节功能恢复满意，是治疗肱骨中下段骨折的一种理想方法。
关键词：肱骨中下段骨折；骨折固定；交锁髓内钉；闭合复位
中图分类号：R687.3 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.01.004
, http://www.100md.com 文章编号：1006-1959(2018)01-0010-03
Therapeutic Effect of Retrograde Interlocking Intramedullary Nail in the Treatment of Middle and Distal Humerus Fractures
LI Jing-wei，ZHOU Zhi-guo，ZHANG Ying-jian，SHANG Fu-qing，SUN Chang-qing
(Tianjin Baodi District People's Hospital，Tianjin 301800，China)
Abstract：Objective To evaluate the clinical effect of closed reduction， retrograde interlocking intramedullary nailing in the treatment of fractures of the middle and lower humerus and to observe the postoperative recovery of shoulder and elbow joints.Methods Analysis of 47 cases of middle and lower humeral fractures in our hospital from January 2010 to August 2017 treated with closed reduction and retrograde interlocking nail fixation. According to AO fracture type，20 cases were type A，15 cases were type B，and 12 cases were type C，postoperative early shoulder elbow functional exercise.Results 45 patients were followed up in 8 ～23 y(average is 15 y).The fractures healed completely and the function of shoulder and elbow was good.Clinical fracture healing time is 14 w，no incision infection，fracture nonunion or internal fixation fracture and other complications.Conclusion Closed reduction and retrograde interlocking nailing in the treatment of middle and distal humerus fractures with simple operation，less trauma，shorter operative time，less bleeding，no damage to the rotator cuff，satisfactory shoulder and elbow joint functional recovery，a ideal treatment of fractures of the middle and lower humerus fracture.
, 百拇医药
Key words：Middle and lower humerus fractures；Fracture fixation；Interlocking intramedullary nail；Closed reduction
肱骨骨折(humeral fracture)是臨床比较常见的长管状骨骨折，据统计约占全身骨折的1%～3%，由于外固定维持复位需制动时间较长，且由于肌肉的牵拉骨折很难维持对位，目前多倾向于早期内固定，术后可早期行功能锻炼。内固定主要分为髓内及髓外，由于桡神经自肱骨中段后侧的桡神经沟中走行，应用钢板内固定需要显露并保护桡神经，操作复杂，并有桡神经损伤的报道。而交锁髓钉内固定具有手术创伤小、并发症少等优点，通过闭合复位，不需显露桡神经，但传统髓钉多顺行由肱骨大结节处进钉，容易引起尖峰处撞击及肩袖损伤[1]，而采用闭合复位逆行入钉具有对肩袖部位无干扰、不需解剖桡神经且髓内固定对桡神经骚扰小等优点。我院自2010年以来采用闭合复位逆行交锁髓内钉治疗肱骨中下段骨折47例，取得较好效果，现报告如下。
1 资料与方法
1.1一般资料 我院自2010年1月～2017年8月共收治肱骨中下段骨折行闭合复位逆行髓钉内固定患者47例，年龄18～66岁，平均35.6岁，其中男36例，女11例。骨折类型(AO分类)A型20例，B型15例，C型 12例，合并挠神经损伤3例，合并其他部位骨折9例，合并胸腹损伤2例。致伤原因：车祸34例，重物砸伤6例，高处坠落伤4例，其他伤3例。, http://www.100md.com(李景伟 周治国 张英剑 商福青 孙长青)
关键词：肱骨中下段骨折；骨折固定；交锁髓内钉；闭合复位
中图分类号：R687.3 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.01.004
, http://www.100md.com 文章编号：1006-1959(2018)01-0010-03
Therapeutic Effect of Retrograde Interlocking Intramedullary Nail in the Treatment of Middle and Distal Humerus Fractures
LI Jing-wei，ZHOU Zhi-guo，ZHANG Ying-jian，SHANG Fu-qing，SUN Chang-qing
(Tianjin Baodi District People's Hospital，Tianjin 301800，China)
Abstract：Objective To evaluate the clinical effect of closed reduction， retrograde interlocking intramedullary nailing in the treatment of fractures of the middle and lower humerus and to observe the postoperative recovery of shoulder and elbow joints.Methods Analysis of 47 cases of middle and lower humeral fractures in our hospital from January 2010 to August 2017 treated with closed reduction and retrograde interlocking nail fixation. According to AO fracture type，20 cases were type A，15 cases were type B，and 12 cases were type C，postoperative early shoulder elbow functional exercise.Results 45 patients were followed up in 8 ～23 y(average is 15 y).The fractures healed completely and the function of shoulder and elbow was good.Clinical fracture healing time is 14 w，no incision infection，fracture nonunion or internal fixation fracture and other complications.Conclusion Closed reduction and retrograde interlocking nailing in the treatment of middle and distal humerus fractures with simple operation，less trauma，shorter operative time，less bleeding，no damage to the rotator cuff，satisfactory shoulder and elbow joint functional recovery，a ideal treatment of fractures of the middle and lower humerus fracture.
, 百拇医药
Key words：Middle and lower humerus fractures；Fracture fixation；Interlocking intramedullary nail；Closed reduction
肱骨骨折(humeral fracture)是臨床比较常见的长管状骨骨折，据统计约占全身骨折的1%～3%，由于外固定维持复位需制动时间较长，且由于肌肉的牵拉骨折很难维持对位，目前多倾向于早期内固定，术后可早期行功能锻炼。内固定主要分为髓内及髓外，由于桡神经自肱骨中段后侧的桡神经沟中走行，应用钢板内固定需要显露并保护桡神经，操作复杂，并有桡神经损伤的报道。而交锁髓钉内固定具有手术创伤小、并发症少等优点，通过闭合复位，不需显露桡神经，但传统髓钉多顺行由肱骨大结节处进钉，容易引起尖峰处撞击及肩袖损伤[1]，而采用闭合复位逆行入钉具有对肩袖部位无干扰、不需解剖桡神经且髓内固定对桡神经骚扰小等优点。我院自2010年以来采用闭合复位逆行交锁髓内钉治疗肱骨中下段骨折47例，取得较好效果，现报告如下。
1 资料与方法
1.1一般资料 我院自2010年1月～2017年8月共收治肱骨中下段骨折行闭合复位逆行髓钉内固定患者47例，年龄18～66岁，平均35.6岁，其中男36例，女11例。骨折类型(AO分类)A型20例，B型15例，C型 12例，合并挠神经损伤3例，合并其他部位骨折9例，合并胸腹损伤2例。致伤原因：车祸34例，重物砸伤6例，高处坠落伤4例，其他伤3例。, http://www.100md.com(李景伟 周治国 张英剑 商福青 孙长青)