加压交锁髓内钉治疗下肢长骨干骨折不愈合及延迟愈合  

Intramedullary compression interlocking nail in treatment of non-union and delayed union of femoral and tibial fractures

作　　者：马克[1] 徐健[1] 张新宁[1] 杨帆[1] 马建东[1] 

机构地区：[1]宁夏医学院第二附属医院骨科,银川750001

出　　处：《中华创伤杂志》2009年第2期145-148,共4页Chinese Journal of Trauma

摘　　要：目的分析下肢长骨干骨折不愈合及延迟愈合的原因，评价加压交锁髓内钉治疗下肢长骨干骨折不愈合及延迟愈合的效果。方法1998年2月-2006年12月，对21例股骨和胫骨干骨折不愈合及延迟愈合者采用加压交锁髓内钉治疗。其中股骨13例，胫骨8例，3例未植骨，仅扩髓加压，5例同时行膝关节松解。结果随访11．4～36个月，平均13．6个月，全部患者均骨性愈合，平均愈合时间8．7个月，无畸形、感染及再骨折出现。采用Klemm分级标准，优19例，良2例。结论下肢长骨干骨折不愈合及延迟愈合主要原因是手术适应证选择不当，手术内固定使用不当，断端血运和骨折愈合生物环境破坏。加压交锁髓内钉治疗下肢长骨干骨折不愈合及延迟愈合具有固定可靠，便于膝、踝早期功能活动，肢体可早期负重等优点。手术应用联合骨移植，扩髓及膝关节松解，可促进骨愈合，改善膝关节功能。Objective To investigate the cause of non-union and delayed union of femoral and tibial fractures and assess the clinical outcome after treatment with intramedullary compression interlocking nail （ICIN）. Methods From February 1998 to December 2006, 21 patients with non-union and delayed union of femoral and tibial fractures （ 13 patients with femoral fractures and 8 with tibial fractures） were treated by ICIN. Bone grafting was performed in 18 patients, and the other three patients only received reamed compression nailing. Five patients received bone grafting combined with knee adhesion release operation. Results All patients were followed up for 11. 4-36 months （mean 13.6 months）. Solid bone union was observed in all patients, with mean bone union time of 8.7 months and without malunion, infection or refracture. According to the Klemm grading, the clinical outcome was graded excellent in 19 patients and good in 2. Conclusions The main causes for non-union and delayed union of femoral and tibial fractures are improper indication selection and incorrect use of implants, which may result in bioenvironment disruption. ICIN shortens the time of functional recovery of knee and ankle joint. ICIN has advantages of stable fixation, early exercise of the knee and ankle as well as early weight loading and hence is one of effective alternatives in treatment of non-union and delayed union of femoral and tibial fractures. ICIN can accelerate the healing of bone and improves the function of knee joint when combined with bone grafting, reamed compression nailing and knee adhesion release.

关 键 词：股骨骨折 胫骨骨折 骨折内固定术 髓内 骨折 不愈合 

分 类 号：R687.3[医药卫生—骨科学]