自1 992年2月～2 0 0 2年1 2月收治股骨干骨折1 92例,对其进行随机分组,分别不同方法进行治疗,并通过平均1 3个月的随访对这3种方法的结果(感染率、不愈合率、愈合时间、膝关节活动度、并发症等)比较如下。1　临床资料1 1　一般资料　1 92例中男1 2 0例,女72例,年龄8～80岁

我科自2003年7月至2009年2月共采用交锁髓内针治疗各类型股骨干骨折136 例,术中遇到各种操作困难而延长手术时间的达34 例.通过认真总结经验教训,在后期的手术中均能有效避免困难产生或快速有效地克服困难.本文旨在总结股骨交锁髓内针术中主要操作困难并给予分析.

髓内钉治疗股骨干骨折的疗效广受肯定.但因其进针点对股骨近端周围血管及软组织的破坏,患者术后可发生医源性股骨骨折、转子周围疼痛固安捷僵硬、股骨头缺血性坏死等一系列临床并发症可能与进针点对股骨近端血管及软组织破坏有密切关系.目前针对髓内钉治疗股骨干骨折选择以大粗隆顶点、转子间窝还是梨状窝为最优进针点仍存在广泛的争议.

Objective To investigate the geometric feature of femoral medullary cavity through CT scanning and it's matching with femoral intramedullary nail,and to analysis the reason for difficulties in implanting distal lock pin. Methods Thirty dried femur specimens were measured through CT scanning,and twenty images were taken evenly according to the total length of shaft of femur from each femur. In each image,the data of the central axis point and eight points around medullary cavity wall in X and Y axes were obtained,which were used to reconstruct the three-dimensional models of medullary cavity,central axis,intramedullary nail by computer software. And the models were overlapped for comparison. Then the coronal and sagittal fold line charts for central axis of medullary cavity were drawn. The inserting process of intramedullary nail was simulated to observe whether the nail would punch out of the medullary cavity wall. Results The central axis of femoral medullary cavity and intramedullary nail were overlapped and compared. They matched well in the coronal plane,but the curves of femoral medullary cavity were larger than those of intramedullary nails in sagittal plane. While simulating the inserting process of intramedullary nail, 6 nails punched out of the medullary cavity wall in coronal plane (20%,6/30),so did 13 nails in sagittal plane (43%,13/30). Conclusion Intramedullary nails match well with most of the femoral medullary cavities. However,the anatomic structure of the femoral medullary cavity differs individually. Curves of some femoral medullary cavity are large,which can cause deformation of intramedullary nail,and this is the main reason for the failure of distal locking.

目的 通过CT 扫描图像对股骨髓腔进行解剖学测量, 模拟分析髓腔与股骨交锁髓内钉的匹配性, 探讨髓内钉手术中远端锁钉置入困难的原因。 方法 对30 个干燥股骨标本进行CT 横断面扫描, 每一个股骨按骨干全长均匀提取20 幅图像, 分别测量每幅图像中轴点及髓腔壁一周8 个点在X、Y 轴上的数据。用三维绘图软件画出髓腔、中轴线、髓内钉在三维空间上的形态, 重叠后进行比对。绘制髓腔中轴冠状面及矢状面的折线型数据图表, 与髓内钉数据结合, 模拟髓内钉插入髓腔, 观察髓内钉切出髓腔壁情况。 结果 将股骨髓腔中轴线与髓内钉重叠后进行比对, 二者在冠状面上较一致, 在矢状面上髓腔弧度较髓内钉大。模拟髓内钉插入髓腔, 冠状面上有6 根髓内钉于股骨标本的中上段切出髓腔内侧或外侧壁, 切出率为20%(6/30), 矢状面上有13 根髓内钉从前缘切出, 切出率为43%(13/30)。 结论 常规股骨交锁髓内钉与大多数股骨髓腔匹配, 但髓腔解剖结构有一定的变异性, 部分髓腔成角过大使髓内钉发生形变是引起髓内钉远端锁钉置入困难的主要原因。

老年人容易发生股骨近端骨折，包括股骨颈骨折、股骨粗隆骨折、股骨粗隆下骨折。尽管外科技术发展很快，但对股骨近端骨折的固定方式还存在一些争议，大多采用关节置换的方法，效果较好，但可造成较大创伤。近年来有专家认为，对老年股骨颈骨折可选择性的进行关节置换，可采用G形臂X线机透视辅助下闭合复位手术 [1] 。我院外二科2012-01-01至2014-12-31共收治41例股骨近端骨折，均在G形臂X线机透视辅助下闭合复位手术治疗，取得较好疗效。