可膨胀髓内钉治疗四肢长骨骨折

目的]探讨可膨胀髓内钉Fixion^TM系统治疗长管状骨骨折的临床应用效果。方法]自2004年9月．2006年1月，共30例患者采用Fixion^TM可膨胀髓内钉系统（Disco-O-tech Herzliya，lsreal）进行治疗；所有患者均为外伤引起的四肢长管状骨骨折，其中男17例，女12例，年龄22—82岁；开放性骨折1例，骨不连患者1例；股骨转子间骨折7例，股骨干骨折9例，肱骨骨折7例，胫骨骨折7例。可膨胀自锁髓内钉（IM）18例，可膨胀交锁髓内钉（IL）5例，股骨近端髓内钉（PF）7例。一般术后10d允许患者部分负重，若负重时患者骨折处出现明显疼痛应推迟。结果]本组30例伤口全部I期愈合，手术时间30～140min，平均65min，术中出血50～1200ml，平均300ml。30例患者全部获得随防，随访时间12～72周，平均40周。术后根据临床和影像学平均愈合时间为：股骨转子间骨折11周，股骨干骨折12．2周，胫骨干骨折13周，肱骨骨折11周。其中1例为肱骨干骨折术后骨不连，再次手术后3个月，骨折处骨痂形成。结论]可膨胀髓内钉应力分布均匀，避免了应力遮挡效应；一般无需扩髓和锁钉．减少了创伤和手术时间，医生和患者接受的X线剂量少和感染率低；轴相弹性动力化固定，加快了骨折愈合时间，避免了交锁髓内钉2次动力化手术给病人带来肉体和精神上的痛苦等。临床初步应用疗效满意，为长管状骨骨折的治疗提供一种新型的理念和固定技术，在掌握好适应证、正确操作的前提下，采用Fixion^TM可膨胀髓内钉系统治疗长管状骨骨折有可能获得较传统交锁髓内钉更好的效果。

Clinicai study of expandable intramedullary nailing systems for the fixation of long-bone fractures

Objective]To investigate the effect of expandable intramedullary nailing systems for the fixation of long-bone fractures.Method]A retrospective analysis of 30 cases with longbone fractures treated by the expandable intramedullary nailing systems(FixionTM system,Disco-o-tech Herzliya,Isreal) was conducted from September 2004 to Jenuary 2006.The study included 30 patients(17 females,13 males;22 to 82 years old),who were fixed with IM(18cases),IL(5 cases) and PF(7 cases).There was one patient with open fracture and another with non-union after operation.Among 30 patients,7 trochanteric,7 humeral,9 femoral and 7 tibial shaft fractures were operated.Most of the patients were permitted to bear some weight 10 days after surgery,unless they felt pain.Result]The surgical time ranged from 30 min to 140 min (averaged 65 min).There were no intraor post-operative complications.All 30 patients were followed up from 12 to 72 weeks postoperatively(mean time was 40 weeks).The average time of bone union according to clinical and radiological evidence were 13 weeks for tibia fractures,12.2 weeks for femoral fractures,11 week for humeral fractures and 11 week for trochanteric fractures.Three months after second operation,bony formation occurred on the patient with nonunion of the humeral fracture.Forteen patients were observed for more than 3 months postoperationally,and the clinical evidences with X-ray results supported that all of them matched the clinical criteria of bone healing.Conclusion]The use of the expandable intramedullary nailing system can avoid stress shielding effect.There is no need for reaming and interlocking,so it can significantly reduce the surgical and the fluoroscopic time.It's longitudinally elastic and dynamic mechanism might promote the healing process of bone.In a word,the expandable intramedullary nailing system offers an effective,simple and minimally invasive procedure for the treatment of long-bone fractures and can avoid many complications.If it is used correctly,a more effective treatment of long-bone fractures would be acquired than the interlocking intramedullary nails.