Acumed前臂髓内钉治疗成人前臂双骨折
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摘要
目的 :探讨Acumed前臂髓内钉治疗成人前臂双骨折的临床疗效。方法:2009年1月至2016年12月采用Acumed髓内钉治疗成人前臂双骨折患者86例,男54例(62.8%),女32例(37.2%),年龄18~72岁,平均36.8岁;右侧50例,左侧36例。记录病例手术时间、术中出血量、放射暴露时间、骨折愈合时间、并发症,DASH问卷调查(Disabilities of the Arm,Shoulder and Hand questionnaire)和Grace-Eversman疗效评级以评估髓内钉治疗前臂骨折的临床效果。结果:86例患者均获随访,随访时间48~144周,平均86.8周;术中出血量30~80 ml,平均52 ml;放射性暴露时间1~6 min,平均2.5 min;手术时间31~55 min,平均46 min。85例骨折顺利愈合,愈合时间10~16周,平均13.3周。3例患者出现并发症,其中1例肥大性骨不连,1例尺桡骨间骨桥形成,1例拇长伸肌腱损伤。DASH评分0~28分,平均15.6分;Grace-Eversman评价结果,优65例,良15例,可5例,差1例。结论:前臂髓内钉用于治疗成人前臂双骨折具有微创、手术时间短、并发症少等优点,临床效果满意。
Objective:To evaluate the results of Acumed intramedullary nail for the treatment of adult diaphyseal fractures of both bone forearm fractures. Methods:From January 2009 to December 2016,86 adult patients with both forearm fractures were treated by intramedullary nail including 54 males and 32 females with an average age of 36.8 years old ranging from 18 to72 years old;There were 50 cases were on the right and 36 cases on the left. The operation time,blood loss and X ray expose time intra operation,time of fracture union,complications,DASH(Disabilities of the Arm,Shoulder and Hand questionnaire),Grace Eversman criteria were recorded to evaluate the clinical outcomes of intramedullary nail for the treatment of forearm fractures. Results:All patients were followed up from 48 to 144 weeks with an average of 86.8 weeks;the blood loss intraoperation was 30 to 80 ml with an average of 52 ml;the the X ray expose time was 1 to 6 min with an average of 2.5 min;the operation time was 31 to 55 min with an average of 46 min;Among them,85 cases healed successfully,the union time was 10 to 16 weeks with an average of 13.3 weeks. There were 1 case of hypertrophic nonunion,1 case of ulnar radial bone bridge formation,and 1 case of extensor hallucis longus tendon injury. The DASH score was 4 to 37(means 15.6);according to Grace Eversman criteria,the results were excellent in 65 cases,good in 15,acceptable in 5,poor in 1. Conclusion:Intramedullary fixation method in treating both bone forearm fractures has advantages of closed application,short operation time,little complication,and clinical outcomes is satisfied.
Objective:To evaluate the results of Acumed intramedullary nail for the treatment of adult diaphyseal fractures of both bone forearm fractures. Methods:From January 2009 to December 2016,86 adult patients with both forearm fractures were treated by intramedullary nail including 54 males and 32 females with an average age of 36.8 years old ranging from 18 to72 years old;There were 50 cases were on the right and 36 cases on the left. The operation time,blood loss and X ray expose time intra operation,time of fracture union,complications,DASH(Disabilities of the Arm,Shoulder and Hand questionnaire),Grace Eversman criteria were recorded to evaluate the clinical outcomes of intramedullary nail for the treatment of forearm fractures. Results:All patients were followed up from 48 to 144 weeks with an average of 86.8 weeks;the blood loss intraoperation was 30 to 80 ml with an average of 52 ml;the the X ray expose time was 1 to 6 min with an average of 2.5 min;the operation time was 31 to 55 min with an average of 46 min;Among them,85 cases healed successfully,the union time was 10 to 16 weeks with an average of 13.3 weeks. There were 1 case of hypertrophic nonunion,1 case of ulnar radial bone bridge formation,and 1 case of extensor hallucis longus tendon injury. The DASH score was 4 to 37(means 15.6);according to Grace Eversman criteria,the results were excellent in 65 cases,good in 15,acceptable in 5,poor in 1. Conclusion:Intramedullary fixation method in treating both bone forearm fractures has advantages of closed application,short operation time,little complication,and clinical outcomes is satisfied.
引文
[1]Crenshaw AH Jr.Fractures of shoulder,arm and forearm.In:Canale ST,Daugherty K,Jones L.Campbell's Operative Orthopaedics[M].10th Edition.St.Louis:Mosby,2003:3049-3058.
[2]Lee SK,Kim KJ,Lee JW,et al.Plate osteosynthesis versus intramedullary nailing for both forearm bones fractures[J].Eur JOrthop Surg Traumatol,2014,24(5):769-776.
[3]Gao H,Luo CF,Zhang CQ,et al.Internal fixation of diaphyseal fractures of the forearm by interlocking intramedullary nail:short term results in eighteen patients[J].J Orthop Trauma,2005,19(6):384-391.
[4]Lee YH,Lee SK,Chung MS,et al.Interlocking contoured intramedullary nail fixation for selected diaphyseal fractures of the forearm in adults[J].J Bone Joint Surg Am,2008,90(9):1891-1898.
[5]Saka G,Saglam N,Kurtulmu T,et al.New interlocking intramed ullary radius and ulna nails for treating forearm diaphyseal fractures in adults:a retrospective study[J].Injury,2014,45 Suppl 1:S16-23.
[6]Schemitsch EH,Jones D,Henley MB,et al.A comparison of malreduction after plate and intramedullary nail fixation of forearm fractures[J].J Orthop Trauma,1995,9(1):8-16.
[7]Sage FP,Smith H.Medullary fixation of forearm fractures[J].JBone Joint Surg Am,1957,39(1):91-98.
[8]Hudak PL,Amadio PC,Bombardier C.Development of an upper extremity outcome measure:the DASH(disabilities of the arm,shoulder and hand)[corrected].The Upper Extremity Collaborative Group(UECG)[J].Am J Ind Med,1996,29(6):602-608.
[9]Grace TG,Eversmann WW Jr.Forearm fractures:treatment by rigid fixation with early motion[J].J Bone Joint Surg Am,1980,62(3):433-438.
[10]Jupiter J,Kellam J.Diaphyseal fractures of the forearm.In:Jupiter J,Browner B.Skeletal Trauma[M].4 Edition.Philadelphia,PA:Saunders Eslevier,2008:1459-1502.
[11]Moed BR,Kellam JF,Foster RJ,et al.Immediate internal fixation of open fractures of the diaphysis of the forearm[J].J Bone Joint Surg Am,1986,68(7):1008-1017.
[12]Rosson JW,Shearer JR.Refracture after the removal of plates from the forearm.An avoidable complication[J].J Bone Joint Surg Br,1991,73(3):415-417.
[13]何永清,沈宝发,顾宣歆,等.带锁髓内钉治疗下肢长骨骨折[J].中国骨伤,2002,15(7):435.HE YQ,SHEN BF,GU XX,et al.Locking intramedullary pin for the treatment of the long bone fracture of the lower limb[J].Zhongguo Gu Shang/China J Orthop Trauma,2002,5(7):435.Chinese.
[14]Rehman S,Sokunbi G.Intramedullary fixation of forearm fractures[J].Hand Clin,2010,26(3):391-401.
[15]Kose A,Aydin A,Ezirmik N,et al.Alternative treatment of forearm double fractures:new design intramedullary nail[J].Arch Orthop Trauma Surg,2014,134(10):1387-1396.
[16]Saka G,Saglam N,Kurtulmus T,et al.Interlocking intramedullary ulna nails in isolated ulna diaphyseal fractures:a retrospective study[J].Acta Orthop Traumatol Turc,2013,47(4):236-243.
[17]Bansal H.Intramedullary fixation of forearm fractures with new locked nail[J].Indian J Orthop,2011,45(5):410-416.
[18]Ozkaya U,Kili A,Ozdo an U,et al.Comparison between locked intramedullary nailing and plate osteosynthesis in the management of adult forearm fractures[J].Acta Orthop Traumatol Turc,2009,43(1):14-20.
[19]Visna P,Vlcek M,Valcha M,et al.Management of diaphyseal forearm fractures using LCP angle stable fixation devices and intramedullary nailing[J].Rozhl Chir,2009,88(12):708-715.
[20]Lee SK,Kim KJ,Lee JW,et al.Plate osteosynthesis versus intram edullary nailing for both forearm bones fractures[J].Eur J Orthop Surg Traumatol,2014,24(5):769-776.
[21]Kose A,Aydin A,Ezirmik N,et al.A comparison of the treatment results of dpen reduction internal fixation and intramedullary nailing in adult forearm diaphyseal fractures[J].Ulus Travma Acil Cerrahi Derg,2017,23(3):235-244.
[22]姚传博,马俊义,李跃蒙,等.四肢骨折合并筋膜间区综合征的治疗[J].中国骨伤,2000,13(10):616.YAO CB,MA JY,LI YM,et al.Treatment of limb fractures combined with compartment syndrome[J].Zhongguo Gu Shang/China J Orthop Trauma,2000,13(10):616.Chinese.
[23]杜胜虎,杨杰,黄祥祥,等.儿童前臂骨折术后尺骨延迟愈合或不愈合原因分析[J].中国骨伤,2014,27(7):605-608.DU SH,YANG J,HUANG XX,et al.Delayed union or nonunion of the ulna after intramedullary nailing for pediatric forearm fractures[J].Zhongguo Gu Shang/China J Orthop Trauma,2014,27(7):605-608.Chinese.
[24]Hong G,Cong Feng L,Hui Peng S,et al.Treatment of diaphyseal forearm nonunions with interlocking intramedullary nails[J].Clin Orthop Relat Res,2006,450:186-192.
[25]Weckbach A,Blattert TR,Weisser C.Interlocking nailing of forearm fractures[J].Arch Orthop Trauma Surg,2006,126(5):309-315.
[2]Lee SK,Kim KJ,Lee JW,et al.Plate osteosynthesis versus intramedullary nailing for both forearm bones fractures[J].Eur JOrthop Surg Traumatol,2014,24(5):769-776.
[3]Gao H,Luo CF,Zhang CQ,et al.Internal fixation of diaphyseal fractures of the forearm by interlocking intramedullary nail:short term results in eighteen patients[J].J Orthop Trauma,2005,19(6):384-391.
[4]Lee YH,Lee SK,Chung MS,et al.Interlocking contoured intramedullary nail fixation for selected diaphyseal fractures of the forearm in adults[J].J Bone Joint Surg Am,2008,90(9):1891-1898.
[5]Saka G,Saglam N,Kurtulmu T,et al.New interlocking intramed ullary radius and ulna nails for treating forearm diaphyseal fractures in adults:a retrospective study[J].Injury,2014,45 Suppl 1:S16-23.
[6]Schemitsch EH,Jones D,Henley MB,et al.A comparison of malreduction after plate and intramedullary nail fixation of forearm fractures[J].J Orthop Trauma,1995,9(1):8-16.
[7]Sage FP,Smith H.Medullary fixation of forearm fractures[J].JBone Joint Surg Am,1957,39(1):91-98.
[8]Hudak PL,Amadio PC,Bombardier C.Development of an upper extremity outcome measure:the DASH(disabilities of the arm,shoulder and hand)[corrected].The Upper Extremity Collaborative Group(UECG)[J].Am J Ind Med,1996,29(6):602-608.
[9]Grace TG,Eversmann WW Jr.Forearm fractures:treatment by rigid fixation with early motion[J].J Bone Joint Surg Am,1980,62(3):433-438.
[10]Jupiter J,Kellam J.Diaphyseal fractures of the forearm.In:Jupiter J,Browner B.Skeletal Trauma[M].4 Edition.Philadelphia,PA:Saunders Eslevier,2008:1459-1502.
[11]Moed BR,Kellam JF,Foster RJ,et al.Immediate internal fixation of open fractures of the diaphysis of the forearm[J].J Bone Joint Surg Am,1986,68(7):1008-1017.
[12]Rosson JW,Shearer JR.Refracture after the removal of plates from the forearm.An avoidable complication[J].J Bone Joint Surg Br,1991,73(3):415-417.
[13]何永清,沈宝发,顾宣歆,等.带锁髓内钉治疗下肢长骨骨折[J].中国骨伤,2002,15(7):435.HE YQ,SHEN BF,GU XX,et al.Locking intramedullary pin for the treatment of the long bone fracture of the lower limb[J].Zhongguo Gu Shang/China J Orthop Trauma,2002,5(7):435.Chinese.
[14]Rehman S,Sokunbi G.Intramedullary fixation of forearm fractures[J].Hand Clin,2010,26(3):391-401.
[15]Kose A,Aydin A,Ezirmik N,et al.Alternative treatment of forearm double fractures:new design intramedullary nail[J].Arch Orthop Trauma Surg,2014,134(10):1387-1396.
[16]Saka G,Saglam N,Kurtulmus T,et al.Interlocking intramedullary ulna nails in isolated ulna diaphyseal fractures:a retrospective study[J].Acta Orthop Traumatol Turc,2013,47(4):236-243.
[17]Bansal H.Intramedullary fixation of forearm fractures with new locked nail[J].Indian J Orthop,2011,45(5):410-416.
[18]Ozkaya U,Kili A,Ozdo an U,et al.Comparison between locked intramedullary nailing and plate osteosynthesis in the management of adult forearm fractures[J].Acta Orthop Traumatol Turc,2009,43(1):14-20.
[19]Visna P,Vlcek M,Valcha M,et al.Management of diaphyseal forearm fractures using LCP angle stable fixation devices and intramedullary nailing[J].Rozhl Chir,2009,88(12):708-715.
[20]Lee SK,Kim KJ,Lee JW,et al.Plate osteosynthesis versus intram edullary nailing for both forearm bones fractures[J].Eur J Orthop Surg Traumatol,2014,24(5):769-776.
[21]Kose A,Aydin A,Ezirmik N,et al.A comparison of the treatment results of dpen reduction internal fixation and intramedullary nailing in adult forearm diaphyseal fractures[J].Ulus Travma Acil Cerrahi Derg,2017,23(3):235-244.
[22]姚传博,马俊义,李跃蒙,等.四肢骨折合并筋膜间区综合征的治疗[J].中国骨伤,2000,13(10):616.YAO CB,MA JY,LI YM,et al.Treatment of limb fractures combined with compartment syndrome[J].Zhongguo Gu Shang/China J Orthop Trauma,2000,13(10):616.Chinese.
[23]杜胜虎,杨杰,黄祥祥,等.儿童前臂骨折术后尺骨延迟愈合或不愈合原因分析[J].中国骨伤,2014,27(7):605-608.DU SH,YANG J,HUANG XX,et al.Delayed union or nonunion of the ulna after intramedullary nailing for pediatric forearm fractures[J].Zhongguo Gu Shang/China J Orthop Trauma,2014,27(7):605-608.Chinese.
[24]Hong G,Cong Feng L,Hui Peng S,et al.Treatment of diaphyseal forearm nonunions with interlocking intramedullary nails[J].Clin Orthop Relat Res,2006,450:186-192.
[25]Weckbach A,Blattert TR,Weisser C.Interlocking nailing of forearm fractures[J].Arch Orthop Trauma Surg,2006,126(5):309-315.