【作者】 赵兴伟；

【导师】 王景彦；

【作者基本信息】 山东中医药大学 ， 中医骨伤科学， 2005， 硕士

【摘要】 目的:肱骨自锁髓内钉是在以往髓内钉基础上设计的一种新型髓内钉,分顺行钉和逆行钉两种类型。本课题的研究目的是对肱骨自锁髓内钉进行生物力学试验,为临床应用提供依据,并对其临床应用进行评价。方法:肱骨自锁髓内钉由主钉、芯柱、锁片(4个)和固定螺母四部分组成。取成人尸体肱骨标本共6根造成人工肱骨干骨折,采用317L不锈钢肱骨自锁髓内钉内固定,对钉骨复合体标本进行生物力学测试,并对肱骨自锁髓内钉单锁片和内芯的抗扭性能进行测试。临床应用39例,顺行插钉15例,逆行插钉24例,并对其临床效果进行评价。结果:肱骨自锁髓内钉抗弯、抗旋及抗拉伸性能均符合生物力学需要。病例随访6～24个月,平均13.4个月,肱骨干骨折均愈合良好。骨折临床愈合时间为9～24周,平均13周。参照评定标准,本组病例临床疗效:优27例,良10例,可2例,优良率94.9%。肩关节功能评定:优31例,良4例,差4例,优良率89.7%。有5例出现来自肱骨自锁髓内钉近端的肩关节撞击症状。本组逆行插钉24例,肘关节功能均恢复良好。结论:肱骨自锁髓内钉将坚强固定与弹性固定有机结合,符合人体生物学固定要求,与肱骨髓腔形态一致,应力遮挡小,利于骨折愈合。肱骨自锁髓内钉具有操作简单、无需X线精确定位、损伤小、疗效好等特点,是治疗肱骨干骨折的有效办法,值得推广。更多还原

【Abstract】 Objective: To study the biomechanical characters of Humerus Self-locking Intramedullary Nail(HSLIN) which is a new type of intramedullary nail consisting of the antegrade and retrograde nail types designed on the basis of previous intramedullary nail and to provide the basic proof for clinical practice and to evaluate its preliminary clinical application. Methods: HSLIN is composed of a main nail, a interior mandril, four locking-sheets and a fixation nut.Six fresh humeral shafts of adult were fracture on purpose.Then fixed the fractures with HSLIN made of 317L stainless steel and took the test of biomechanics.The stiffness of single locking-sheet and interior mandril also were test to resist twisting momentum.39 cases patients of humerus shaft fracture were treated with HSLIN,of whom 15 cases were treated with antegrade HSLIN and 24 cases with retrograde HSLIN.The results were evaluated based on a criteria including clinical and radiographic parameters. Result: HSLIN resisted certain curving,twisting,pulling force,which might meet biomechanic needs.With an average of 13.4 months(range 6~24 months)of follow-up,all cases acquired bony union with mean union time 13 weeks(range 9~24 weeks).According to the criteria,27 patients were evaluated as having excellent result, 10 good.The overall excellent or good rate was 94.9%.The recovery of shoulder function was excellent in 27 cases,good in 4 cases,and fair in 2 cases,and the overall excellent or good rate was 94.9%.The recovery of elbow function was excellent in all cases.5 cases had shoulder impingement caused by the tail of HSLIN. Conclusion: HSLIN is in accordance with the humerus medullary cavity shape and biomechanics of human body. HSLIN belonging to the well-organized combination of flexible fixation and firm fixation,has lower shelter,benefits the bone,and has many other advantages,such as less trauma and good results, reasonable structure and simple manipulation , without X-ray guidance.更多还原