摘要
背景:带锁髓内钉固定作为股骨干骨折治疗的首选方法具有诸多优点,但术后仍存在一定程度的骨折不愈合率,同时对于术后骨折不愈合的处理尚无统一标准。目的:探讨股骨干骨折带锁髓内钉固定术后出现骨折不愈合及延迟愈合的原因,以及再次手术治疗的方法和疗效。方法:2005年1月至2011年12月共收治股骨干骨折带锁髓内钉固定术后骨折不愈合及延迟愈合22例,男13例,女9例;年龄18～66岁,平均41.5岁;骨折不愈合19例,延迟愈合3例。汇总骨折分型、手术方法及影像学资料特征等资料,分析造成骨折不愈合及延迟愈合的原因,并随访再次手术后的效果。结果:22例患者中切开复位11例;钢丝环扎3例;术后骨折间隙>10mm8例;髓内钉过细或过短3例;出现深部感染2例;伴随有糖尿病等慢性消耗性疾病6例。19例骨折不愈合患者进行再次手术治疗,包括骨折端清理、自体髂骨松质骨植骨、附加或更换内固定物稳定骨折端等,术后随访6～28个月,平均13.2个月,骨折愈合时间3～8个月,平均4.2个月,3例延迟愈合病例经7～13个月观察均获得骨性愈合。结论:股骨干骨折带锁髓内钉固定术后骨折不愈合及延迟愈合的原因既有自身因素,又存在手术干预过程的力学、生物学因素。骨折不愈合病例应根据其出现的原因及特点制定适当的手术方案,再次术后治疗效果满意。
Background： Interlocking intrameduUary nailing is a preferred treatment for lemoral slaatt tracture. But oone nonumon sometimes occur and there is no standard guideline for fracture nonunion management. Objective： The aim of the study is to investigate the causes of femoral shaft fracture nonunion and delayed union after interlocking intramedullary nailing. Methods： From January 2005 to December 2011, 19 patients with bone nonunion and 3 patients with delayed union after interlocking intramedullary nailing for femoral shaft fracture were treated in our hospital. There were 13 males and 9 females with a mean age of 41.5 years （range 18 to 66 years）. The clinical outcomes of the secondary treatment were observed. Results： Eleven patients underwent open reduction and three patients were treated with steel wire. More than 10mm gap was found in 8 cases after operation. Intramedullary nail was not suitable in 3 cases. Deep infecton occurred in 2 cases. Six patients had chronic diseases, for example, diabetes. In the 19 cases of fracture nonunion, surgical treatment was performed, the follow-up ranged from 6 to 28 months （13.2 months on average）, and the bone healing time ranged from 3 to 8 months （4.2 months on average）. Conclusions： Many factors may contribute to fracture nonunion and delayed union after interlocking intramedullary nail fix- ation. Clinical outcomes of surgical treatment are good for nonunion and delayed union of femoral shaft fracture.
出处
《中国骨与关节外科》
2012年第6期485-487,共3页
Chinese Journal of Bone and Joint Surgery
