Ender釘固定成績不良例の考察

Failure of Ender Nailingfor Different Reasons. Report of 3 Cases

　Ender釘術後に他の内固定具で再手術が必要となった3例を経験した．症例1は挿入nailが短く骨折部での回旋不安定が原因となりnailが折損，脱落した．症例2は免荷が守れずnailの折損が生じた．症例3は片麻痺症例でnail先端が菲薄化した皮質骨を穿破した．Ender釘固定はフレキシブルであり，多くの長管骨骨折に適応があり，低侵襲であるという利点もある．ただし，今回経験した症例のように，Ender法の術後成績はnailの位置，骨強度や後療法によって影響を受けやすく，安定した成績を得ることは決して容易ではない．一方，Ender釘は多発外傷例や低侵襲手術が必要な例に適応があることから，適応を慎重に検討したうえで習熟すべき技術と考える．

　We report three cases of failure of Ender nailing.　All three cases were later successfully treated with other internal fixation devices.　Case 1：69-years-old man；Ender nail broke and penetrated humeral cortex.　We consider the shortness of nail length was the cause of the failure.　Case 2：A37-years-old woman with schizophrenia；three cephalo-condylar nails had broken.　We consider the patient had a poor understanding of the postoperative rehabilitation program.　Case 3：48-years-old woman with hemiplegia；Ender nails penetrated the osteoporotic femoral condylar cortical bone because the patient is hemiplegia as a result of cerebral hemorrhage.　Ender nailing is less invasive and provides elastic fixation.　Although, Ender nailing is technically demanding and is difficult to get satisfactory results in every cases, Ender nailing can be indicated especially for poly trauma cases and the cases required less invasive treatment.