AO交锁髓内针治疗下肢骨折43例.docVIP

AO交锁髓内针治疗下肢骨折43例【摘要】目的：探讨AO交锁髓内针对下肢骨折的治疗效果。方法：根据病人骨折骨髓腔的大小及骨折复杂性、粉碎性骨折碎程度选择适合于病人的最大型号髓内针和不同类型的导杆，在硬外膜麻醉状态下切开复位，在导向器辅助下插入髓内针固定骨折端。结果：本组43例，拔针39例，无1例发生弯针、断针，无1例影响髋、膝关节功能。骨折愈合时间5~8个月，拔针时间平均12~15个月。结论：AO交锁髓内针能更有效地治疗下肢骨折。 【关键词】AO交锁髓内针；下肢骨折；治疗 文章编号：1009-5519（2008）07-0972-02 中图分类号：R6 文献标识码：A Treatment of crural fracture with AO interlocking intramedullary nail XIAO Liu-bin，LIU Guo-xiong （Department of Orthopedics，The People’s Hospital of Longhua，Shenzhen 518109，China） 【Abstract】Objective：To study the curative effect for the treatment of crural fracture with AO interlocking intramedullary nail. Methods：To choose the fitting type interlocking intramedullary nail and leader based on the site of marrow cavity，the degree of complexity and crushing of the crural fracture in difference patients，all the patients were operated to diaplasis with epidural anaesthesia，and the interlocking intramedullary nail was inserted to fix the fracture by the help of the leader. Results：43 cases of crural fracture were cicatrized in 5~8 monthes，and pulled out the nail in 12~15 monthes，39 cases of them were pulled out the nail，no case happened to bend or rupture， and no case had functional obstruction in coxa joint and knee joint. Conclusion：AO interlocking intramedullary nailcan treat the crural fracture effectively. 【Key words】AO interlocking intramedullary nail；Crural fracture；Treatment 传统髓内针和接骨板在临床上常常多用于治疗四肢横形和短斜形骨折。对于复杂性、粉碎性骨折，长斜形及螺旋形骨折，传统髓内针和接骨板内固定稳固性较差，易造成内固定物疲劳断裂。据此，近年来我科逐渐开展使用AO交锁髓内针治疗下肢骨折，发现AO交锁髓内针对下肢骨折的治疗效果远较传统内固定为佳，现报道如下： 1 资料与方法 1.1 一般资料：本组43例，男28例，女15例，年龄22~45岁，平均28岁。多段股骨骨折11 例，多段胫骨骨折15例，中上1/3Ⅱ型复杂性、粉碎性骨折12例，中下1/3Ⅲ型复杂性、粉碎性骨折2 例，Ⅳ 复杂性、粉碎性骨折3例(Winquist分型)。 1.2 AO交锁髓内针的特点：AO交锁髓内针截面呈开口三叶形，厚度为1.2 mm，有胫骨和股骨两种交锁髓内针 ，股骨交锁髓内针的纵轴曲率半径为1.5 m，远侧用4.5 mm螺钉两只固定。此针内固定时使用瞄准器穿螺钉，不需要X线机辅助，可减少对医物人员的创伤，且该针为实心，具有更大的钢性，交锁髓内针 固定后，患肢可早期负重[1]。 1.3 手术方法 1.3.1 交锁钉的选择：根据病人骨折骨髓腔的大小及骨折复杂性、粉碎性骨折程度而定，一般选择适合于病人的最大型号髓内针。 1.3.2 导杆插入：按照骨折类型选择不同的导杆（标准骨折选用直导杆，严重移位的用弯头导杆，骨髓腔闭合者用铲形导杆）