股骨干骨折钢板内固定失效更换髓内钉固定的改良手术方法  

Modified intrameduilary nailing after failed plating for femoral shaft fractures

作　　者：毛玉江[1] 武长江 孙林[1] 朱仕文[1] 王满宜[1] 

机构地区：[1]北京积水潭医院创伤骨科,100035 [2]河北省承德县医院外三科

出　　处：《中华创伤骨科杂志》2012年第11期964-967,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的介绍一种针对股骨干骨折不愈合伴钢板内固定失效后行再次髓内固定的改良手术技术。方法2006年1月至2009年12月共收治8例股骨干骨折钢板内固定失效患者，男7例，女1例；平均年龄为41．1岁（19-61岁）。7例患者钢板断裂，1例患者钢板未断但螺钉拔出，骨折均未获愈合。首次手术至钢板失效接受本次手术时间平均为12．4个月（4-30个月）。手术步骤：①X线机透视下经皮闭合取出所有螺钉，留置钢板；②同侧或对侧髂骨取骨，此步骤可由另一组手术人员与步骤①同时进行；③置入髓内钉；④切开骨折端，取出钢板，确认对位良好，清理瘢痕组织并植骨；⑤髓内钉远端锁定。5例患者采用顺行髓内钉固定，2例采用逆行髓内钉固定，1例采用股骨近端髓内钉周定。结果8例患者均顺利完成更换髓内钉困定手术，手术时间平均为2．6h（2．0-3．5h），术中失血培平均为1100mL（600-1500mL）。术后1年随访8例患者骨折均获愈合，愈合时间平均为5，5个月（4-8个月），无感染等其他并发症发生。结论本文所介绍的改良手术技术可减少股骨干骨折不愈合伴钢板内固定失效后行再次髓内固定的手术失血量，其技术难点为经皮闭合取钉及硬化髓腔的再通。Objective To report a modified surgical technique of intramedullary nailing to treat failed plating for femoral shaft fractures. Methods From January 2006 to December 2009, we treated 8 patients with non-union of femoral shaft fracture after plating failure. They were 7 men and one woman, with an average age of 41. 1 years （from 19 to 61 years）. Plate breaking occurred in 7 patients and screw pull-out in one. The average interval between the primary surgery and the salvage surgery after non-union was 12.4 months （from 4 to 30 months） . The surgical procedures were： l. percutaneous screw removal under X-ray with the plat retained; 2. ipsilateral or contralateral harvest of the lilac graft, which was done sinmhaneously as step 1 by another team; 3. implantation of intramedullary nails; 4. opening the fracture site, removing the plate, confirming alignment, cleaning the scar tissue and grafting; 5. distal locking of intramedullary nails. Anterograde nails were used in 5 cases, retrograde ones in 2 and the femoral proximal nail in one. Results The secondary surgery, was successfully completed in all cases to change the intramedullary nailing. The av- erage surgery time was 2.6 hours （from 2.0 to 3.5 hours）, and the average surgical blood loss was 1100 mL （from 600 to 1500 mL）. The one-year follow-up showed fracture union in all the 8 cases after an average time of 5.5 months （from 4 to 8 months）, with no infection or other complications. Conclusions This modified surgical technique of intramedullary nailing can significantly reduce blood loss during the revision surgery for the non-union of femoral shaft fracture after plating failure. The percutaneous screw removal and the recanalization of hardened marrow cavity may be 2 technical difficulties.

关 键 词：股骨骨折 骨折 不愈合 骨折固定术 内 骨钉 手术方法 

分 类 号：R687.3[医药卫生—骨科学]