摘要: Department of Orthopaedics，Shanghai Zhabei Central Hospital，Shanghai200070 【Abstract】 Objective To study the opportune moment of operation and methods in treatment of limb’s long bone diaphysial fracˉture with intramedullarynailing。Methods 113cases of long bone diaphysial fracture were tre......
【Abstract】 Objective To study the opportune moment of operation and methods in treatment of limb’s long bone diaphysial fracˉture with intramedullarynailing.Methods 113cases of long bone diaphysial fracture were treated with intramedullary nailing within1to14days after injuried.Among them，54cases were treated with kuntscher nailing and V type nailing，and59cases were treated with interˉlocking intramedullary nailing.Results The total healing rate of fracture was94.7%，which92.6%in kuntscher nailing and V type nailing，96.6%in interlocking intramedullary nailing.Conclusion It is beneficial to use intramedullary nailing in early treatment to inˉcrease the fracture healing.The method is simple.The complication is a little and the healing rate is good with intramedullary nailing.
Key words limb’s long bone fracture V type plum blossom type interlocking type intramededullary nail
We have treated113cases of limb’s long bone fracture with intramedullary nailing from August1990to November2002.That method of treatment has characteristic of good curative effect and high healing rate.Now report it as follows.
1 Patients and methods
1.1 Patients Among all113cases，79cases are men;34are women，whose age ranges from25to75（average，43）.97cases are traumatic fracture and16cases are pathological fracture.Injury cause of97cases can be seen in table1.Primary diseases of16cases can be seen in table2.
Table1 Injury causes of traumatic fracture（略）
Table2 Primary diseases of pathological fracture（略）
Of all patients the shortest time of reaching hospital after inˉjury is one hour，and the longest time is3days.Most of the paˉtients come to hospital within24hours.All patients have unique symptom and physical sign of deformity or abnormal motion.Part of fracture can be seen in table3.86cases are close fracture;27are open fracture.
Table3 Part of fracture（略）
In113cases，4cases are multiple fracture.We list the most serious part of them into the statistic table（table4）.29cases are comminuted fracture.3cases are fracture combining with injury of nerve.5cases combined with shock，still3cases with injury of other organs.
1.2 Methods To those patients combining with shock and other injuries，we must firstly give emergent treatment to save their lives，taking therapy of anti-shock and cure combined injury.Take active treatments of fracture when general conditions of paˉtients are stable.
All113cases have been taken operation of intramedullary fixˉation within1～14days after injury.We had used“V”type nailˉing or plum blossom type nailing in humerus and femur，triangle nailing in radius and ulna，enders nailing in tibia and fibula to treat altogether54cases before1994.Since1995，with the extenˉsive use of interlocking intramedullary nailing，the other59cases have all been treated with it，except for fracture of ulna，radius and fibula.
We usually take follow-up survey once about every2～3months.The longest time is36months;the shortest is12months（average，16months）.The survey included clinical manifestation and X-ray photograph.In the end，107cases out of113healed well（healing rate:94.7%）.In54cases treated with kuntscher nailing and“V”type nailing，50cases healed well（92.6%）.In59cases with interlocking intramedullary nailing，57cases healedwell（96.6%）. 107patients’survey who healed well can be seen in table4.
Table4 Survey of107fracture patients who heal well （略）
In6cases who do not heal well or don’t heal at all，4cases are caused byinfection;1case falls again5months after operation;anˉother1case suffering from central hemiparesis also hasn’t healed.
3.1 Choice of intramedullary nail Intramedullary fixation deˉmands stability in vertical direction and anti-rotation.So it is betˉter for us to choose interlocking intramedullary nail in the diaphysis fracture of femur，tibia and humerus，especially in the fracture of femur and distal1/3of tibia or multi-fracturein one bone.Beˉcause of its interlocking，it can control the fracture piece tostop shortening deformity and keep it in good position firmly.Finally it realizes the purpose of controlling the displacement of rotation and duplication，etc ［1］ .But it is unsuitable to use interlocking inˉtramedullary nail in fractureof long bone’s2ends.On condition that the distance between fracture line and screw is too close，which is unsuitable for interlocking intramedullary nailing，we can choose Ender’s nail.We can also use plum blossm type nail in transverse fracture of femur’s middle-upper end.In ulna，radius and fibula，we usually choose triangle nail.
3.2 Significance of early operation Early intramedullary fixation operation of limb’s long bone fracture is easy to take reduction andachieve good position which will reduce complication，the course of diseaseand pain of patient ［2，3］ .Fat embolism and ARDS may occur in clinic after operation.We take operation when the condition of disease is stable.The operationwill not only make it easy for motion of sick limb but put fracture in good position and reduce pain of paˉtient as well，which，to certain extent，prevent the occur of compliˉcation said above.If the patient comes to hospital3days after injury we should take operation within10～14days after injury，when swelling oflimb becomes to extinct.Remember，avoid unnecessary pull and insertion of intramedullary nail in operation.
1 Luo Xianzheng，Wang Zongren，Liu Changgui.Grosse-kKempf clinical application of interlocking intramedullary nail.Journal of China orˉthopaedics，1993，13（3）:173.
2 Papc HC.Pulmorary damage after intramedullary femoral nailing in trauˉmatized-Is there a form different nailing methods?J Trauma，1992，33:574.
3 Donald A，Wiss MD.Unstable of the tibia treated with a reamed inˉtramedullary interlocking rail.J Clin Orthop，1995，315:56.