更换髓内钉治疗股骨干骨折髓内钉内固定术后骨不连:12例资料回顾性分析  

Exchange nailing for postoperative nonunion following intramedullary nailing of femoral diaphyseal fracture:A retrospective analysis of 12 cases

作　　者：李福春[1] 谷贵山 金成浩[1] 车明学[1] 

机构地区：[1]吉林大学第一临床医学院骨关节一科,吉林省长春市130021

出　　处：《中国组织工程研究与临床康复》2007年第47期9584-9586,共3页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:通过对12例股骨干骨折髓内钉内固定术后骨不连患者进行更换髓内钉治疗的回顾性分析,观察股骨干骨折髓内钉内固定术后骨不连更换髓内钉治疗的疗效。方法:选择吉林大学第一临床医院2004-03/2006-09住院的股骨干骨折髓内钉内固定术后骨不连患者12例。其中男9例,女3例。更换髓内钉治疗:手术取出原有髓内钉,扩大骨髓腔,更换比原有髓内钉长2～4cm且直径粗1～3mm的髓内钉,其中3例骨缺损致接触面积<50%的病例取同侧髂骨行植骨治疗。12例患者获得随访,随访时间为6～24个月,平均13.75个月。分别于术后1,3,6个月拍X射线片检查,观察材料及宿主反应。按Neer评定标准进行功能评估。结果:①6个月时12例患者均参加随访,8～15个月时每月各1例,21,22,24个月时各1例。②12例中9例术后6～9个月X射线片显示达到骨性愈合,平均7.33个月。3例骨移植病例于术后8～11个月X射线片显示达到骨性愈合,平均9.67个月;骨性愈合率100%。③按Neer评分标准评估疗效结果:85分以上1例,70分以上11例。④所用髓内钉等植入物未发现有腐蚀、断裂等情况,未发现急慢性全身及局部反应。结论:更换髓内钉治疗具有促进骨不连愈合的生物学和力学效应,是治疗股骨干骨折髓内钉内固定术后骨不连的有效方法。AIM： To observe therapeutic effect of exchange nailing for postoperative nonunion following intramedullary nailing of femoral diaphyseal fracture through a retrospective analysis of twelve cases. METHODS： All 12 cases （9 males and 3 females） were selected from the First Clinical Hospital of Jilin University from March 2004 to September 2006. Exchange nailing treatment included the removal of the current intramedullary nail, reaming of the medullary canal, and placement of an intramedullary nail that was 2-4 cm longer and 1-3 mm larger in diameter than the removed nail. And the autogenous lilac crest bone graft was used for three patients, whose bone loss was less than 50% of the circumference. All 12 cases received the follow-up for 6-24 months, with an average value of 13.75 months. All cases were examined by X-ray test on 1, 3, 6 months after operation to observe stuff and host response. The Neer score was adopted to evaluate the functional assessment. RESULTS： ①AII cases took part in follow-ups on 6 months, there was separately one patient for follow-up per month from months 8 to 15 and on months 21, 22, 24.②Nine of twelve patients achieved osseous union within a mean of 7.33 （6 to 9） months, while other three patients achieved osseous union within a mean of 9.67 （8 to 11） months, and the rate of osseous union was 100%.③According to the Neer score for functional assessment, there was one case over 85 and other eleven cases 70. ④No corrosion and breakage of bone graft, acute or chronic general and local response was found in all patients. CONCLUSION： Exchange nailing provides biological and mechanical effects that promote osseous healing, it can be used to effectively treat postoperative nonunion following intramedullary nailing of femoral diaphyseal fracture.

关 键 词：股骨 髓内钉 骨不连 更换髓内钉 

分 类 号：R683.42[医药卫生—骨科学]