逆行交锁髓内钉治疗股骨远端骨折延迟愈合及不愈合  

Treatment of Delayed Union and Nonunion of Fractures in the Distal Part of Femurs with Retrograde Interlocking Nail

作　　者：廖永兴[1] 杨召[1] 李天鹏[1] 

机构地区：[1]云南省第一人民医院骨科,昆明市650032

出　　处：《中国骨与关节损伤杂志》2005年第3期169-171,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的观察逆行交锁髓内钉治疗股骨远端骨折延迟愈合、不愈合的临床疗效。方法9例股骨远端骨折延迟愈合及不愈合,并伴膝关节不同程度关节功能活动障碍患者,行手术取出内固定,膝关节软组织松解,骨折复位,逆行交锁髓内钉内固定,并取自体髂骨植骨,术后配合CPM行患肢膝关节功能锻炼。结果术后随访16～26个月全部患者均获得骨性愈合,无内固定物松动、断裂。膝关节功能活动明显改善。结论逆行交锁髓内钉治疗股骨远端骨折延迟愈合、不愈合,临床效果满意,特别适宜在其它内固定物失败的情况下使用。治疗的关键在于术中膝关节软组织充分松解,骨折块准确复位,扩髓并正确插入合适的髓内钉,静力固定,植骨及术后积极地功能锻炼。Objective To investigate the clinical effect of retrograde interlocking nailing on the treatment of delayed union and nonunion of fractures in the distal part of femurs.Methods Nine cases of delayed union or non-union of fractures in the distal part of femurs with various movement limitation of knee were included.The surgical procedure included the removal of steel plate and screws,the relieving of knee extensor mechanism and the reduction of fractured fragments.The iliac bone grafting and retrograde interlocking nail were used finally to fix the fractured fragments.All patients were encouraged to perform functional excises of knee joint under CPM assistance after operation.Results Sixteen～26 months follow-up revealed the bony healing in all cases.No loosing or break occurred and knee movements were improved markedly.Conclusion The retrograde interlocking nail is satisfactory for the treatment of the delayed union and nonunion of fractures of the distal part of femurs,while other internal instruments usually failed at the site.The key factors of surgery lies in the complete relieving of knee soft tissue,precise reduction of bone fragments and correct insertion of nail with appropriate diameter as well as static fixation,bone grafting and active knee excise after operation.

关 键 词：交锁髓内钉治疗 骨折延迟愈合 股骨远端 不愈合 逆行 关节功能活动障碍 交锁髓内钉内固定 膝关节功能锻炼 自体髂骨植骨 内固定物松动 膝关节软组织 软组织松解 临床疗效 不同程度 手术取出 骨折复位 术后配合 骨性愈合 

分 类 号：R683.42[医药卫生—骨科学] R683[医药卫生—外科学]