带锁髓内钉治疗股骨干骨折的并发症原因分析及预防  

Cause analysis and prevention of the complications of the femoral shaft fractures treated with interlocking nails

作　　者：吴峰[1] 卢绍燊[1] 叶志军[1] 陈希聪[1] 

机构地区：[1]佛山市中医院骨科,广东佛山528000

出　　处：《中国骨伤》2005年第8期464-465,共2页China Journal of Orthopaedics and Traumatology

摘　　要：目的:分析带锁髓内钉治疗股骨干骨折的并发症发生原因,探讨预防措施.方法:利用带锁髓内钉治疗股骨干骨折521例,男435例,女86例,平均年龄31岁(16～72岁).骨折按AO分类:A1型57例,A2型66例,A3型96例,B1型62例,B2型99例,B3型75例,C1型33例,C2型21例,C3型12例.结果:所有患者经11～48个月(平均18个月)的随访,优良率为90.2%.共出现并发症154例:血管损伤2例,神经损伤3例,脂肪栓塞综合征11例,术中骨折7例,感染7例,深静脉栓塞4例,锁钉误穿2例,主钉折断5例,锁钉断裂9例,锁钉松脱13例,术后再骨折7例,骨不连17例,异位骨化23例,膝关节粘连41例,骨折畸形愈合3例,无骨筋膜室综合征,并发症总发生率为29.6%.结论:应用带锁髓内钉治疗股骨干骨折具有较好的疗效,但需防范带锁髓内钉使用中并发症的出现.Objective：To analyze the causes of the complication of femoral shaft fractures treated with interlocking nails and explore the preventive measures. Methods： Five hundreds and twenty-one patients（435 male, 86 female, the average age of 31 years, ranging in age from 16 to 72 years） were treated with interlocking nail. Femoral shaft fractures were classified by AO principles：Type Al in 57 cases ,A2 in 66 ,A3 in 96,B1 in 62,B2 in 99,B3 in 75 ,C1 in 33, C2 in 21 ,C3 in 12. Results：All patients were followed up for an average of 18 months（from 11 to 48 months） ,the excellent and good rate was 90.2%. Among 154 patients with complications：Vascular injuries was found in 2 cases, nerve injuries in 3 cases, fat embolism in 11 cases, fracture during operation in 7 cases,infection in 7 cases,deep venous thrombosis in 4 cases,mis-insertoin of locking nails in 2 cases, main nail broken in 5 cases, locking nail broken in 9 cases, locking nail loose in 13 cases, postoperative re-fractuve in 7 cases, unhealing of fracture in 17 cases, heterotopic ossification in 23 cases, adhesion of knee in 41 cases, malunion in 3 cases. No compartment syndrome was found, with the total incidence of complications being 29.6 %. Conclusion： Interlocking nail is an excellent alternative for the treatment of femoral shaft fractures. But it is necessary to reduce the complication.

关 键 词：股骨骨折 骨折固定术 髓内 并发症 带锁髓内钉治疗 股骨干骨折 原因分析 预防 脂肪栓塞综合征 骨筋膜室综合征 

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