股骨干骨折髓内置钉治疗骨折不愈合20例:附加钢板结合植骨的有效性  

Interlocking intramedullary nails for postoperative nonunion of femoral fractures in 20 cases:Effectiveness of plate combined with bone graft

作　　者：郝建学[1] 张建鹏[1] 李兵[1] 刘燕梅[1] 任康[1] 刘锁利[1] 万建设[1] 任永敏[1] 陈美青[1] 李雪波[1] 

机构地区：[1]保定市第一医院骨科,河北省保定市071000

出　　处：《中国组织工程研究与临床康复》2010年第13期2441-2444,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景：前交锁髓内钉是大部分股骨干骨折的首选治疗方法,纵观目前对于股骨干骨折髓内钉治疗后骨折不愈合的治疗方法,主要集中在更换原有髓内钉和改用钢板固定并植骨治疗方面,手术创伤大,费用高,术后不能早期功能锻炼,患者不易接受。目的：随访观察不更换原有髄内钉,直接附加钢板结合植骨治疗股骨干骨折髓内钉固定后骨折不愈合的效果。方法：回顾分析保定市第一医院骨外科2006-02/2008-12收治的20例股骨干骨折交锁髓内钉固定后不愈合患者,采用不更换原有髄内钉直接附加钢板并结合植骨的方法治疗。手术采用外侧切口,骨折端周围骨膜及骨痂给予保留,清理骨折端的纤维组织及硬化骨,术中检查骨折端稳定性差,于股骨前外或后外侧给予用7-9孔窄有限接触钢板固定,固定钢板处不剥离骨膜,骨折远近端各用3枚螺钉固定,固定后骨折端稳定,取自体髂骨植于骨折端,植骨后不负重或部分负重功能锻炼,骨折愈合后完全负重。结果与结论：20例患者均得到随访,随访时间8-12个月,骨折全部愈合,愈合时间3-10个月,平均5个月,术后肢体活动良好。附加钢板结合植骨治疗股骨干骨折髓内钉固定后骨折不愈合,手术操作创伤小,可以综合交锁髓内钉和钢板内固定的优点,克服这两种内固定的不足,提高骨折固定稳定性,使患者早期进行功能锻练,促进骨折愈合,是一种简单有效的治疗方法。BACKGROUND：Interlocking intramedullary nail is the prior choice for femoral fractures.Previous studies have shown that treatments for nonunion of femoral fractures following intramedullary nail concentrate on replace nails or changed to plate fixation,which is unacceptable for patients due to great trauma and high cost. OBJECTIVE：To explore the effect of plate combined with bone graft on the postoperative femoral fractures nonunion treated by interlocking intramedullary nail. METHODS：Twenty cases of postoperative femoral fracture nonunion treated by interlocking intramedullary nail from February 2006 to December 2008 were entered in our surgery.They received operations to remove the fibrous tissue and sclerosis bone.Then anterolateral or posterolateral of femoral was fixed by 7-9-well forearm plates,and the fracture ends were fixed using 3 nails.After fixation,the autogenous iliac bone was grafted at fracture end.After treatment,patients receive functional exercise without weight-bearing or with weight-bearing,which turned to full weight-bearing when the fracture was united. RESULTS AND CONCLUSION：All 20 cases were available for follow up.The follow-up lasted for 8-12 months.All cases achieved solid union within 3-10 months,averaged 5 months.There was no disorder of limb＇s activity.Plate combined with bone graft is characterized by simple operation,reliable effect and early motion,which is an ideal method for treatment of postoperative femoral fractures nonunion treated by interlocking intramedullary nail.

关 键 词：交锁髓内钉 钢板 股骨干骨折 植骨 骨折不愈合 硬组织植入物 

分 类 号：R318[医药卫生—生物医学工程]