带锁髓内针治疗股骨干骨折术后旋转不稳定所致不愈合的诊断和治疗  

The diagnosis and treatment of rotational unstable nonunion of femoral shaft fracture after interlocking nailing

作　　者：赵刚[1] 张伯松[1] 孙林[1] 吴新宝[1] 

机构地区：[1]北京积水潭医院创伤骨科,100035

出　　处：《中华外科杂志》2009年第16期1232-1235,共4页Chinese Journal of Surgery

摘　　要：目的探讨带锁髓内针治疗股骨干骨折旋转不稳定形成不愈合的发生机制，治疗方法及临床疗效。方法2003年4月至2007年6月，18例股骨干骨折带锁髓内针固定后发现存在旋转不稳定，造成了骨折不愈合，通过扩髓，更换带锁髓内针，或者附加钢板固定，同时行自体骨植骨来进行治疗。结果18例患者均得到随访，时间为12—58个月，平均28个月。所有骨折均愈合，愈合时间为6—8个月，平均为7个月。围手术期未发生并发症。术后无髓内针和钢板松动。结论带锁髓内针固定股骨干骨折的不愈合多是由于旋转不稳定造成的，扩髓后更换直径更大的带锁髓内针重新固定，或者辅助钢板固定，加上自体骨植骨是治疗这种不愈合的有效方法。Objective To evaluate the principle and treatment of rotational unstable nonunion of the femoral shaft fracture after interlocking nailing. Methods From April 2003 to June 2007, 18 cases of rotational unstable nonunion of femoral shaft fractures after interlocking nailing were treated with exchanged reamed nailing and/or LCP fixation and iliac bone graft. The average age was d0 years old （ from 22 to 52）. Results All patients were followed up for an average time of 28 months （from 12 to 58）. All the fractures were united in an average time of 7 months （from 6 to 8 ）. There were no perioperative complications occurred and no wound infection were observed. No loosening was found around the implant till the last follow-up. Conclusions Rotational instability is one of the reasons of nonunion of femoral shaft fracture after interlocking nailing. Reaming and nail exchanging or LCP fixationg with iliac bone graft are the appropriate methods which can achieve a great clinic results.

关 键 词：股骨骨折 骨折 不愈合 带锁髓内针 

分 类 号：R686[医药卫生—骨科学]