髓内钉治疗股骨干骨折扩髓与不扩髓的比较研究

目的探讨非扩髓钉是否比扩髓钉操作简单、迅速、安全。方法用前瞻性随机研究方法将100例单纯股骨干骨折随机分为扩髓组与非扩髓组,比较二组的手术时间、失血量、手术中意外情况的发生。结果扩髓组37例手术时间138min,失血量278ml,6例术中发生意外情况。非扩髓组63例,手术时间108min(P=0．012),失血量186ml(P=0．034)。17例术中发生意外情况,2例需二次手术。结论非扩髓钉操作步骤少,手术时间及失血量少于扩髓组,但非扩髓组手术中意外情况发生较多,虽然统计学差异不显著。     

扩髓髓内钉与锁定接骨板治疗股骨干骨折的疗效比较

目的观察股骨扩髓髓内钉（RIN）和锁定接骨板（LCP）治疗股骨干骨折患者的临床疗效。方法对50例股骨干骨折患者分别采用RIN内固定（25例）和LCP内固定（25例）治疗。对比两组患者手术时间、术中失血量、切口长度、住院时间、术后8周骨痂面积、功能评价情况。结果50例均获得随访,时间RIN组11～28个月、LCP组10～32个月。术中出血量、住院时间及Flynn功能评价两组差异均无统计学意义（P〉0．05）。RIN组手术时间较LCP组长、切口长度较LCP组短、术后第8周骨痂面积比LCP组大,差异均有统计学意义（P〈0．05）。结论RIN与LCP两种内固定方式均能取得良好的治疗效果,但RIN组术后骨痂形成较多,骨折愈合情况更为理想。     

非扩髓带锁髓内钉治疗粉碎性股骨干骨折

股骨干骨折是临床常见的多发性骨折 ,特别是在高能量损伤情况下造成股骨干粉碎性、多段骨折 ,复位固定非常困难 ,不仅骨折粉碎程度高 ,而且往往伴有严重软组织损伤。我们自 1998年始采用非扩髓小切口带锁髓内钉对该类骨折进行治疗 ,效果满意。1　临床资料本组 4 5例中男 32例 ,女 13例 ;年龄 2 0～ 63岁 ,平均 35岁。致伤原因 :车祸伤 35例 ,高处坠落伤 6例 ,重物砸伤 4例 ,均属股骨干粉碎性骨折 ;按Ｗｉｎ ｑｕｉｓｔ等[1] 方法分类 :Ⅰ度 12例 ,Ⅱ度 8例 ,Ⅲ度 17例 ,Ⅳ度 8例。2　手术方法开放性骨折急症清创后行带锁髓内钉内固定治疗 ,…     

扩髓换钉治疗股骨干骨折术后骨不连26例

目的探讨股骨干骨折交锁钉内固定术后骨不连的理想治疗方法。方法重新扩髓后，闭合更换比原来粗1～2mm交锁髓内钉，全部静力型固定。结果全部病例3～11个月内骨性愈合。结论本方法创伤小，可操作性强，符合骨折愈合的生物力学原理，是治疗骨干骨折术后骨不连的较好方法。     

交锁髓内钉扩髓与不扩髓的比较

髓内钉技术的进步和交锁髓内钉概念的提出使得髓内钉应用范围越来越广泛,交锁髓内钉已成为治疗长管状骨骨干骨折的标准治疗方法.扩髓型交锁髓内钉可提高固定的稳定性和机械强度,不扩髓型可有效降低对骨内膜血供的干扰,两者孰优孰劣存在很大争议.该文就两种方法对股骨骨折愈合、胫骨骨折愈合、肺功能、发生感染机会的影响进行比较.     

髓内钉治疗股骨干骨折进展

股骨干骨折主要发生于年轻人,多由严重创伤所致。髓内钉固定治疗股骨干骨折具有创伤小、闭合复位不破坏骨外膜血运、促进骨痂生长、可早期负重等优点,被视为治疗股骨干骨折的金标准。该文就髓内钉治疗股骨干骨折的历史、现状及存在的问题,如扩髓与不扩髓、锁定与动力化调整、闭合复位与开放复位等作一综述。     

闭合交锁髓内钉扩髓治疗Ⅲ型以上股骨干骨折26例

自2002年6月～2003年12月采用闭合交锁髓内钉扩髓治疗Ⅲ型以上股骨干骨折26例，取得了满意的疗效。     

不扩髓交锁髓内钉治疗胫骨开放性骨折

对于胫骨开放性骨折 ,往往由于皮肤和软组织损伤严重 ,骨折端血供破坏 ,治疗较为困难。国内外对此类骨折的治疗有不同见解 ,尤其对骨折固定方法无统一认识。 1998年 1月～ 2 0 0 1年 12月 ,我们应用不扩髓交锁钉治疗 36例胫骨开放性骨折 ,取得良好的效果。1　材料与方法1.1　病例资料　本组 36例 ,男 2 6例 ,女 10例 ,年龄 2 0～ 6 2岁。跌伤 9例 ,车祸 2 3例 ,压伤 4例 ,均为开放性骨折。Gustillo分型 :Ⅰ型 16例、Ⅱ型 13例、ⅢA型 5例、ⅢB 型 2例。外伤至手术的时间为 2～ 7h ,平均 4h。1.2　治疗方法　彻底清创后采用不扩髓交锁钉技…     

不扩髓带锁髓内钉治疗胫骨骨折

本组病例24例，其中男16例，女8例。年龄20～61岁，平均36岁。受伤原因：车祸伤11例，高处坠落伤8例，重物砸伤3例，钝器伤2例。左侧15例，右侧9例，开放性骨折8例。骨折按AO分类法：所有病例均为42-C型，42-C1型8例，42-C2型3例，42-C3型14例。所有病例均在48h内手术，开放性骨折6h内施术。     

扩髓带锁髓内钉治疗股骨骨折不愈合24例报告

目的 评价扩髓带锁髓内钉治疗股骨骨折不愈合的临床疗效。方法 1998年9月一2001年12月对24例股骨骨折不愈合患者采用扩髓带锁髓内钉进行治疗，行开放复位、扩髓和植骨。采用X线检查及膝关节活动度对结果进行评价。结果 随访6—28个月，平均12．5个月，所有病例均骨性愈合，愈合时间12—28周，平均22周；无感染、脂肪栓塞综合征、再骨折及断钉等并发症发生。随访膝关节活动度优16例，良6例，可l例，差l例。结论 股骨骨折不愈合的主要原因为内固定方式选择及治疗不当，固定技术不完善。使用扩髓带锁髓内钉治疗股骨骨折不愈合，具有内固定可靠，便于膝关节早期功能锻炼等优点。同时粉碎颗粒状骨移植可促进骨折愈合，临床应用效果满意。     

Reamed versus unreamed intramedullary nailing for the treatment of femoral shaft fractures among adults: A meta-analysis of randomized controlled trials

BackgroundThe purpose of this meta-analysis is to compare the merits and drawbacks between reamed intramedullary nailing (RIN) and unreamed intramedullary nailing (URIN) among adults.MethodsWe comprehensively searched PubMed, MEDLINE database through the PubMed search engine, Google Scholar, Cochrane Library, Embase, VIPI (Database for Chinese Technical Periodicals), and CNKI (China National Knowledge Infrastructure) from inception to March 2020. Outcomes of interest included nonunion rates, implant failure rates, secondary procedure rates, blood loss, acute respiratory distress syndrome (ARDS) rates, and pulmonary complications rates.ResultsEight randomized controlled trials were included. The result of nonunion rates shows that the nonunion rate is significantly lower in the RIN group (RR = 0.20, 95% CI = 0.09–0.48, Z = 3.63, P = 0.0003). There were no significant differences for the risk of implant failure rates (RR = 0.55, 95% CI = 0.18–1.69, Z = 1.04, P = 0.30). The secondary procedure rates were significantly lower in the RIN group (RR = 0.28, 95% CI = 0.12–0.66, Z = 2.91, P = 0.004). The result shows that the blood loss of URIN group is significantly lower (RR = 145.52, 95% CI = 39.68–251.36, Z = 2.69, P = 0.007). The result shows that there was no significant difference in the ARDS rates (RR = 1.53, 95% CI = 0.37–6.29, Z = 0.59, P = 0.55) and the pulmonary complications rates between RIN group and URIN group (RR = 1.59, 95% CI = 0.61–4.17, Z = 0.94, P = 0.35).ConclusionsReamed intramedullary nailing would lead to lower nonunion rate, secondary procedure rate and more blood loss. Unreamed intramedullary nailing is related to a higher nonunion rate, secondary procedure rate and less blood loss. No significant difference is found in implant failure rate, ARDS rate and pulmonary complication rate between the two groups.     

The incidence of non-union following unreamed intramedullary nailing of femoral shaft fractures

Introduction

Stabilisation of fractures with an intramedullary nail is a widespread technique in the treatment of femoral shaft fractures in adults. To ream or not to ream is still debated. The primary objective of this study was to determine the incidence of non-union following unreamed intramedullary stabilisation of femoral fractures. Secondary objectives were intra- and postoperative complications and implant failure.

Methods

Between March 1995 and June 2005, 125 patients with 129 traumatic femoral shaft fractures were treated with as unreamed femoral nail. From this retrospective single centre study, 18 patients were excluded due to insufficient follow up data, including 1 patient who died within 2 days after severe head injury. Sixty-six patients had suffered multiple injuries. 21 fractures were open. According to the AO classification, there were 54 type A, 42 type B, and 14 type C fractures. Dynamic proximal locking was performed in 44 cases (36 type A and 8 type B fractures).

Results

Non-union occurred in two patients (1.9%; one type B and one type C fractures). Intra-operative complications were seen in three patients (2.8%). Postoperative in-hospital complications occurred in 29 patients (27%). Local superficial infection occurred in two patients (1.9%), there were no cases of deep infection. Implant failure occurred in three patients (2.8%): nail breakage was seen in two patients.

Conclusion

In this study, the incidence of non-union following unreamed intramedullary nailing is low (1.9%) and comparable with the best results of reamed nailing in the literature.     

Tibial fractures Reamed versus unreamed intramedullary nailing

AMEDLINEsearchwasperformedtoidentifystudiespublishedfromJanuary1997toNovember2003com-paringreamedintramedullary(IM)nailingwithun-reamedIMnailingfortibialfractures.Fromalistof16articles,threerandomizedclinicaltrialscomparingreamedIMnailingtounreamedIMnailingwereidentified.Weincludedstudiesexaminingbothopenandclosedtibialfractures.Weexcludedanalysesofnonrandomizedtrials.StudiesStudy1KeatingJF,OBrienPJ,BlachutPA,etal(1997)Lockingintramedullarynailingwithandwithoutreamingforopenfractur…     

Femoral shaft fractures——Reamed versus unreamed intramedullary nailing

AMEDLINEsearchwasperformedtoidentifystudiespublishedfromJanuary1998toJanuary2003comparingreamedwithunreamedintramedullarynailinginfemoralshaftfractures.Fromalistof11articlesidentifiedfromthesearchstrategy,threearticles,alleitherrandomizedorquasi-randomizedclinicaltrials,wereidentifiedthatmadethedesiredcomparison.Weexcluded1randomizedtrialwhosemainoutcomewastransesophagealechocardiographyforquantificationofemboliusingreamedandunreamedfemoralnailing.Wealsoexcluded:fivecaseseries,oneprelimina…     

Reamed or unreamed intramedullary nailing for tibial fractures: a meta-analysis

Objective：To compare the treating effects of different intramedullary nailing methods on tibial fractures in adults.Methods：Literature reports in both Chinese and English languages were retrieved （from the earliest available records to October 1,2013） from the PubMed,FMJS,CNKI,Wanfang Data using randomized controlled trials （RCTs） to compare reamed and unreamed intramedullary nailing for treatment of tibial fractures.Methodological quality of the trials was critically assessed,and relevant data were extracted.Statistical software Revman 5.0 was used for data-analysis.Results：A total of 12 randomized controlled trials,comprising 985 patients （475 in the unreamed group and 510 in the reamed group）,were eligible for inclusion in this meta-analysis.The results of metaanalysis showed that there were no statistically significant differences between the two methods in the reported outcomes of infection （RR=0.64; 95％CI,0.39 to 1.07;P=0.09）,compartment syndrome （RR=1.44; 95％CI,0.8to 2.41; P=0.16）,thrombosis （RR=1.29; 95％CI,0.43to 3.87; P=0.64）,time to union （WMD=5.01; 95％CI,-1.78 to 11.80; P=0.15）,delayed union （nonunion）（RR=1.56; 95％CI,0.97 to 2.49; P=0.06）,malunion （RR=1.75; 95％CI,1.00 to 3.08; P=0.05） and knee pain （RR=0.94; 95％CI,0.73 to 1.22; P=0.66）.But there was a significantly higher fixation failure rate in the unreamed group than in the reamed group （RR=4.29; 95％CI,2.58to 7.14; P＜0.00001）.Conclusion：There is no significant difference in the reamed and unreamed intramedullary nailing for the treatment of tibial fractures,but our result recommends reamed nails for the treatment of closed tibial fractures for their lower fixation failure rate.     

胫骨骨折--扩髓和不扩髓髓内钉比较

关于这个主题的文献质量不高，因此很难得出一个结论，究竟是扩髓钉还是不扩髓钉的效果更好。这个报告提示：对于开放或闭合性胫骨骨折，两种治疗方法在骨愈合率和并发症上没有统计学差异，建议对患者的功能和生活质量进行更深入和详细的评价和分析研究。     

非扩髓凹槽交锁髓内钉治疗开放性胫骨骨折

目的 介绍凹槽交锁髓内钉治疗胫骨开放性骨折的手术方法、特点及其适应证。方法 胫骨开放性骨折28例，按Gustilo分型：Ⅰ型18例，Ⅱ型8例，Ⅲa型2例，采用凹槽髓内钉直径8mm26例，直径7mm2例。结果 所有患不需X线透视均精确锁定，骨折复位良好，固定牢固，经平均5．6个月随访，伤口无感染，骨折均骨性愈合，无针、钉断裂发生。结论 凹槽交锁髓内钉具有操作简单，创伤小，适应证范围广，固定牢固以及不扩髓等优点。     

扩髓与非扩髓髓内钉固定治疗胫骨闭合性骨折的系统评价

[目的]系统评价扩髓髓内钉(reamed intramedullary nailing,RTN)与非扩髓髓内钉(unreamed intr-amedullary nailing,UTN)治疗胫骨闭合性骨折的疗效。[方法]通过计算机检索、手工检索和其他检索方法,收集RTN与UTN治疗胫骨闭合性骨折的随机对照试验(randomized controlled trials,RCT)和半随机对照试验(quasi-ran-domized controlled trials,CCT),按Cochrane协作网推荐的方法进行系统评价。[结果]共纳入6个RCT研究,总病例数为1214例。Meta分析显示:(1)RTN组的骨折不愈合率低于UTN组,差异有统计学意义(RR=0.41;95%CI(0.21,0.78),P=0.007);(2)RTN组的内置物失败率低于UTN组,差异有统计学意义(RR=0.32;95%CI(0.20,0.50),P<0.000 1);(3)RTN组与UTN组术后畸形愈合率及感染率差异无统计学意义,两者相对危险度分别为0.45(95%CI(0.16,1.22),P=0.12)、0.45(95%CI(0...     

钢板内固定和髓内钉固定治疗肱骨干骨折的系统评价

[目的]对钢板内固定与髓内钉固定治疗成人肱骨干骨折的疗效进行系统评价.[方法]在Pubmed、Co-chrane Library、EMBASE、Science Direct以及CNKI、CBM、中国医学学术会议论文数据库等网站进行检索.文献检索起止时间为1995年1月～2010年9月.再对入选文献的参考文献进行手工检索.系统收集钢板内固定和髓内钉固定治疗肱骨干骨折的相关文献,并按临床科研方法的国际通用原则进行阅读和评价.采用Cochrane协作网提供的软件Revman 4.2进行Meta-分析,以获得钢板内固定和髓内钉固定治疗肱骨干骨折的疗效及其安全性指标的相关证据.[结果]共检索到192篇原始文献,有6篇符合最终的入选标准,总计随访患者335例.Meta分析结果表明,钢板内固定与髓内钉固定比较,可显著降低再次手术发生率但是增加术后感染率.[结论]钢板内固定可显著降低再次手术发生率但是增加术后感染率.在骨折不愈合率、医源性神经损伤等方面,两者差异无统计学意义.因本次系统评价纳入病例数较少,尚需要更多设计严谨的大样本随机对照研究来增加证据的论证强度.