CAJ | 학술논문

目的设计一种螺纹弹性髓内钉(threaded elastic intramedullary nail,TEIN),观察其在闭合复位下固定锁骨骨折的疗效.方法用钛合金(Tc4)或不锈钢(317L)材料加工TEIN,直径1.5、2.0和2.5 mm三种,长250 mm.TEIN近端为正圆锥体尖,相邻有15-150 mm长,且高出于钉体0.5 mm的自攻螺纹;远端为正三角形刃.2004年1月至2008年1月,采用闭合复位内固定55例(56根)锁骨骨折患者.男44例.女11例;年龄9-72岁,中位年龄31.0岁.内1/3横行骨折4根,中1/3骨折41根(横行骨折11根,斜行骨折17根,粉碎性骨折13根),外1/3骨折11根(按Craig分型:Ⅱ型7根.V型4根).结果手术时间15-60 min,平均35.6 min.术后6-24周取出TEIN,平均取钉时间为8.8周.随访时间1-4年,平均3.4年.骨折恢复解剖学形态者33例(58.9%);恢复解剖学长度,对位较好17例(30.4%);4例中1/3粉碎性骨折,2例外1/3 Craig V型骨折骨折片未复位;总复位优良率为89.3%.中1/3骨折于肩锁关节内侧断钉1例;皮下形成滑囊24例(42.9%);局部皮肤形成压疮Ⅰ期14例,Ⅱ期5例(33.9%).外1/3骨折者术后1年时,肩关节Constant总评分为87.1(79.0-100.0)分.结论 TEIN可以闭合复位固定治疗锁骨骨折,具有微创、美观、促进骨折愈合和减少并发症等优点.
목적 설계일충라문탄성수내정(threaded elastic intramedullary nail,TEIN),관찰기재폐합복위하고정쇄골골절적료효.방법 용태합금(Tc4)혹불수강(317L)재료가공TEIN,직경1.5、2.0화2.5 mm삼충,장250 mm.TEIN근단위정원추체첨,상린유15-150 mm장,차고출우정체0.5 mm적자공라문;원단위정삼각형인.2004년1월지2008년1월,채용폐합복위내고정55례(56근)쇄골골절환자.남44례.녀11례;년령9-72세,중위년령31.0세.내1/3횡행골절4근,중1/3골절41근(횡행골절11근,사행골절17근,분쇄성골절13근),외1/3골절11근(안Craig분형:Ⅱ형7근.V형4근).결과 수술시간15-60 min,평균35.6 min.술후6-24주취출TEIN,평균취정시간위8.8주.수방시간1-4년,평균3.4년.골절회복해부학형태자33례(58.9%);회복해부학장도,대위교호17례(30.4%);4례중1/3분쇄성골절,2예외1/3 Craig V형골절골절편미복위;총복위우량솔위89.3%.중1/3골절우견쇄관절내측단정1례;피하형성활낭24례(42.9%);국부피부형성압창Ⅰ기14례,Ⅱ기5례(33.9%).외1/3골절자술후1년시,견관절Constant총평분위87.1(79.0-100.0)분.결론 TEIN가이폐합복위고정치료쇄골골절,구유미창、미관、촉진골절유합화감소병발증등우점.
Objective To design a threaded elastic intramedullary nail (TEIN) and to explore its clinical application of clavicular fracture.Methods The TEIN is made by titanium alloy (Tc4) or stainless steel (317L).The nail is designed with tapping screw thread in the proximal end and a sharp tail.The length of nail was 250 mm with different diameter.From January 2004 to January 2008,55 patients with 56 clavicle fractures were included in the study.There were 44 male and 11 female patients with a median age of 31.0 years.Four patients had a transverse fracture in the proximal third of the clavicle;41 patients had a fracture with varied fragments in the middle third,including transverse fracture in 11 patients,oblique fracture in 17 and comminuted fracture in 13;and 11 patients had distal clavicular fracture,including type Ⅱ in 7 patients,type Ⅴ in 4,according Craig classification.Results The average operative time was 35.6 min (range,15-60).The removal time of the nail was 6-24 weeks of fracture fixation,with a mean of 8.8 weeks.The follow-up time ranged from 1 to 4 years,with the mean of 3.4 years.Thirty-three patients (58.9%) had achieved anatomical reduction.Seventeen patients (30.4%) had attained functional reduction.Four patients with comminuted fracture of the middle third of the clavicle and 2 patients with Craig V fracture had not been reduced.The excellent and good rate was 89.3%.Breakage of the nail was observed in one patient. Subcutaneous bursae synovialis formation was found in 24 patients.Pressure sores were found in 19 patients who consisted of 14 patients in stage Ⅰ and 5 in Ⅱ.The mean Constant and Murley score in patients with disial clavicular fracture was 87.1 points (range,79.0-1 00.0).Conclusion Intramedullary fixation of midshaft clavicular fractures with a TEIN is a safe minimally invasive surgical technique achieving primary stability for practice.