Elastic intramedullary nail for treating 22-A fracture in the forearm of adults

doi:10.3969/j.issn.2095-4344.0162

Abstract

Abstract:

BACKGROUND: Elastic intramedullary nail is commonly used in the treatment of fractures of children, but few studies concern the elastic intramedullary nail for treating fractures in adults.

OBJECTIVE: To investigate the repair effect of elastic intramedullary nail in the treatment of 22-A fracture in forearm of adults.

METHODS: From January 2015 to April 2016, a total of 21 adult patients with the 22-A fracture (35 fractures) were treated with manipulative reduction and elastic intramedullary nail fixation in the First Affiliated Hospital of Guangzhou University of Chinese Medicine. The follow-up time was 12-18 months. Radiographs were taken and the guidance of the limb function training was given at regular intervals. The Andserson scoring system was used to evaluate the patients’ forearm limb function. Fracture healing, elbow, wrist joint activity and forearm rotation were recorded. The satisfactory questionnaires were recorded. The patients were divided into three grades as satisfaction, general satisfaction and dissatisfaction; simultaneously, reasons were recorded.

RESULTS AND CONCLUSION: (1) The Andserson scoring was satisfactory in 16 cases accounted for 76%, general satisfaction in 3 cases accounted for 14%, dissatisfaction in 2 cases accounted for 10%. (2) Wrist joint activity increased from (172±4)° before the operation to (181±3)° at the end of the follow-up. Elbow joint activity increased from (102±18)° before the operation to (124±13)° at the end of the follow-up. Forearm rotation activity increased from (84±11)° before the operation to (155±13)° at the end of the follow-up (P < 0.05). (3) In the follow-up of the 21 patients, 13 patients were satisfied with the result of surgery; 5 patients were generally satisfied; 2 patients were dissatisfied because the limited limb functions; and 1 patient was dissatisfied because of the nail irritability; the dissatisfaction rate accounted for 14%. (4) Elastic intramedullary nail can obtain affirmative effect in the treatment of adult 22-A fracture of the forearm; and clinical application should be based on the type of fracture.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Ulna Fractures, Radius Fractures, Bone Nails, Internal Fixators, Tissue Engineering

CLC Number:

R318

Chen Hao, Li Min-ying, Pan Jun-xi, Li Shao-shuo, Wan Lu-chao, Sun Han-qiao, Zhao Jing-tao. Elastic intramedullary nail for treating 22-A fracture in the forearm of adults[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(11): 1677-1682.

Figures/Tables 1

2.1 参与者数量分析纳入成人前臂22-A型骨折接受手法复位弹性髓内钉固定患者27例，在随访过程中3例患者拒绝随访，2例患者失访，1例患者因脑血管疾病无法完成随访，最终21例患者完成随访，共35处骨折。试验流程图见图1。 2.2 一般结果本组21例患者手术时间 20-60 min，平均40 min；术中出血量 7-50 mL，平均20 mL；临床愈合时间8-24周，平均15周。21例患者中Andserson功能评分优16例，占76%；满意3例，占14%；2例不满意，占10%。末次随访患者腕关节活动度、肘关节活动度及前臂旋转活动度均显著提高，差异有显著性意义(P < 0.05)，见表1。 21例患者中13例对手术效果满意，5例患者一般满意，2例患者因肢体功能受限、1例因为钉尾激惹对手术效果不满意，不满意率为14%。 2.3 不满意结果 2例因肢体功能受限术后不满意患者均为尺桡骨干双骨折，接受弹性髓内钉固定治疗后，1例患者因惧痛拒绝早期手部、腕、肘屈伸锻炼，术后15周仍未开始行前臂旋转练习；术后3个月复查前臂正侧位片示骨折端对位对线良好，已有连续骨痂连接，腕关节活动度为110°，肘关节活动度为90°，前臂旋转活动度为60°；术后6个月X射线片示骨折断端由编织骨连接；术后12个月X射线片示骨折线消失，塑性良好；末次随访腕关节活动度为135°，肘关节活动度为90°，前臂旋转活动度为80°。另一例为尺桡骨干开放性骨折合并尺神经、正中神经损伤患者，入院时患者前臂掌背侧各有一约10 cm伤口，部分肌肉缺如，软组织损伤严重，清创缝合并VSD覆盖2次，患者伤口组织细菌培养未见明显异常，于第3次清创缝合时行手法复位并弹性钉内固定，1周后再次清创缝合完全闭合伤口并行石膏外固定术；术后6个月片显示骨折端对位对线良好，已有连续骨痂连接；术后12个月示骨折断端由编织骨连接，末次随访腕关节活动度为120°，肘关节活动度为70°，前臂旋转活动度为60°，遗留第4，5指麻木，屈伸功能障碍。 1例患者出现钉尾激惹，骨折愈合后取出弹性钉症状缓解。 2.4 典型病例男性患者，20岁，因外伤致左尺桡骨干双骨折入院，入院时腕关节活动度约150°，肘关节活动度约105°，前臂旋转活动度约75°，患者既往无其他外伤史及其他内科系统疾病史，排除手术禁忌证后，行左尺桡骨骨折闭合复位弹性髓内钉固定治疗，术后石膏固定1周以减少术口疼痛，并指导患者早期活动手指以及肘、腕关节屈伸锻炼，4-6周后逐步行前臂旋转练习。术后6个月复查X射线检查示骨折端大量骨痂生长，塑性良好，骨折线基本消失；术后8个月取出弹性钉后复查X射线检查示骨折已愈合，骨痂进一步塑性；腕关节活动度提高至185°，肘关节活动度提高至140°，前臂旋转活动度提高至160°，患者肢体功能基本不受影响，患者对此次治疗满意，见图2。"

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