Intramedullary nail internal fixation for the treatment of humeral fracture

doi:10.3969/j.issn.2095-4344.2013.04.021

Abstract

Abstract:

BACKGROUND: At present, for the treatment of humeral fracture, there has not yet been formed uniform treatment mode which is fixed and accepted by most scholars, and there are disagreements on the indications and surgical timing of humeral fracture treated with intramedullary nail internal fixation.
OBJECTIVE: To analyze the pathological anatomy, healing process and injury typing of humeral fracture and to investigate the indications and surgical timing of humeral fracture treated with intramedullary nail internal fixation.
METHODS: The purpose of the treatment of complex humeral fractures was to restore the necessary functional or anatomical bits, achieve stable fixation and placement, thus get the early-stage functional exercise. The articles concerning the treatment of humeral fractures with intramedullary nail internal fixationwere summarized to find out the cases with the similar treatment objects and the same curative effect evaluation criteria for the comparative study, in order to provide basis for the clinical treatment of humeral fractures.
RESULTS AND CONCLUSION: For the treatment of humeral fractures, it is important to critically assess the type of fracture and bone quality and to select the suitable intramedullary nail during the treatment of humeral fractures. Understanding the type of intramedullary nail and the manner of internal fixation, recognizing the value of different types of intramedullary nail placement for the treatment of humeral fractures as well as taking the effective measures to prevent the related complications during the treatment of humeral fractures with intramedullary nail internal fixation can help to obtain the satisfactory results during the treatment of humeral fractures.

Key words: bone and joint implants, academic discussion of bone and joint implants, humeral fractures, intramedullary nail, prosthesis replacement, fracture fixation, locking plate, fracture type, anatomy, shoulder function, fracture healing, complications

CLC Number:

R318

Wang Yi-min, Xu Kai-ming, Huang Xing-zhong, Huang Ai-jun, Li Zhong-tan, Ma Shu-qiang. Intramedullary nail internal fixation for the treatment of humeral fracture[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(4): 696-703.

Figures/Tables 11

1 肱骨髓内钉的种类肱骨骨折多数可通过手法复位，夹板固定治疗，但对一些不稳定性骨折常需要切开复位置入固定。髓内钉固定为切开复位提供了基础。其对骨折块骨膜和骨折端软组织血运干扰小、应力遮挡小、去除固定后再骨折少、固定力度大、避免了不必要的植骨、手术时间短、出血少、不需要外固定、感染概率相对小等优点，越来越多的运用于临床。 1.1 Gross-Kempf钉 20世纪70年代后期，Gross和Kempf[8]对内锁钉作了改进，以远近端的两枚横向锁钉为特征，近端1/3不开槽，而且较远端粗，配有打入器和近、远端锁钉瞄准器，远端锁钉的穿针必须在影像增强装置的引导小金星，成为Gross-Kempf钉。 1.2 鱼口交锁髓内钉[9] 鱼口状交锁髓内钉整体采用不锈钢无缝管制成，外表面两侧具有纵形凹槽，下部开有槽口呈鱼口状，前端为喇叭形，上部加工有一横孔，上端具有内螺纹，顶开有定位口。置入必须在X射线辅助下进行，可牢靠固定骨折，缩短手术时间，胫骨和肱骨都可以使用。 1.3 全锁髓内钉 1997年，吴岳嵩等[10]报道对Huckstep钉修改而成的金属髓内钉。可在直视下打入髓内钉和锁钉，不需要X射线辅助，并且达到解剖对位的可能性较大。 1.4 非扩髓型肱骨内锁髓内钉[11] 该钉是由髓内针、内锁螺钉和尾部钉3部分构成。当内锁髓内钉安装完毕后，尾部钉通过髓内钉顶端的内螺纹拧入，防止软组织长入，便于取钉。 1.5 Seidel钉[12] Seidel钉为自带锁肱骨髓内钉，可通过定位器拧入。用该钉治疗AO角钢板固定失败的肱骨骨折也取得了成功。 1.6 髓内扩张自锁钉 1998年李健民等[13]在组合式防旋髓内钉的基础上改良而成。具有不扩髓、不需要X射线定位、抗疲劳极限高、无明显应力集中等优点。 1.7 可降解生物髓内钉 1998年Vander Elst等[14]采用多聚乳酸及多聚羟基乙酸混合物制成髓内钉应用山羊的股骨骨折，经过2.5年的随访，骨折愈合良好，而肱骨较股骨在抗重力和抗旋转等方面的要求更小一些，此类髓内钉很快会用于临床。"

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