外固定架临时加压交锁髓内针再次锁定治疗交锁髓内针动力化后股骨干骨折不愈合  

The treatment of nonunion of femoral shaft fractures after intramedullarynaildynamizationwith temporary compres- sion using external fixator followed by relocking of the internal intramedullary nail

作　　者：黄雷 杨胜松[1] 滕星[1] 王陶[1] 汤文杰[1] 吴新宝[1] Huang Lei;Yang Shengsong;Teng Xing;Wang Tao;Tang Wenjie;Wu Xinbao(Department of Orthopaedic Trauma,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院创伤骨科,100035

出　　处：《中华骨科杂志》2019年第1期17-22,共6页Chinese Journal of Orthopaedics

基　　金：首都临床特色应用研究与成果推广课题(Z161100000516052).

摘　　要：目的探讨外固定架临时加压后交锁髓内针再次锁定治疗交锁髓内针动力化后股骨干骨折不愈合的方法及疗效。方法 回顾性分析2006年3月至2017年7月采用外固定架临时加压交锁髓内针再次锁定治疗2例顺行交锁髓内针动力化后股骨干骨折不愈合和1例逆行交锁髓内针术后骨折不愈合取出髓内针的患者资料,女2例,男1例;年龄分别为24、50、66岁;左2例,右1例;肥大型骨折不愈合2例,营养不良型骨折不愈合1例;骨折分别位于股骨远端、中段和近端。对于2例顺行髓内针远端动力化的患者在股骨转子区和股骨髁部于交锁髓内针内缘垂直于股骨干矢状面的解剖轴自前向后各平行拧入2枚外固定架半针;对于1例逆行髓内针近端未锁定的患者分别在股骨转子区和股骨髁部自外向内垂直于股骨干冠状面解剖轴于髓内针后部拧入2枚半针;均使用单边重建外固定架将位于股骨远、近端的2组半针相连,并采用牵拉-加压器将两者间距离缩短10~15 mm,股骨干骨折不愈合两端加压后,在因动力化而取出锁钉的一端交锁髓内针钉孔内再次置入2枚锁钉,而后去除外固定架。结果 术后第1天,1例即可完全负重行走,1例因心理问题扶拐部分负重12个月后完全弃拐行走,1例扶拐1个月后完全弃拐行走。X线片显示骨折愈合,2例为术后7个月,1例为术后12个月。术后3例患者均获得随访,随访时间分别为25、22和7个月;无一例患者出现感染征象;患侧髋、膝和踝关节活动度均正常。1例术后25个月时要求并接受髓内针取出术,取出术后37个月复查时无不适主诉。结论 外固定架临时加压交锁髓内针再次锁定是治疗交锁髓内针动力化后股骨干肥大型和营养不良型骨折不愈合的一种方法,具有微创、简单、术后早日恢复功能的优点。Objective To introduce the technique we invented to treat hypertrophic and oligotrophic nonunion of femoral shaft fracture after dynamization of intramedullary nail (IMN) and to report its preliminary results.Methods The data of 2 cases with hypertrophic nonunions of femoral shaft fracture and 1 case with oligotrophic nonunion following IMN dynamization who had been treated by the technique from March 2006 to July 2017 in Beijing Jishuitan hospital were retrospectively studied. There were 2 females and 1 male, aged 50, 66 and 24 years old. 2 parallel half pins were inserted from anterior to posterior at the trochanteric and condylar zones of the femur for antegrade intramedullary nailing patients, and from lateral to medial sides for retrograde intramedullary nailing patient respectively, then the pins were connected with monolateral limb reconstruction fixator. The fracture nonunion site was compressed by the fixator up to 10-15 mm. The holes at the end of intramedullary nail where their screws were removed for dynamization were locked again with 2 locking screws, and then the frame was removed. The patients are allowed to start their rehabilitation and fully bear their body weight 1 day after the operation.Results The three patients were followed up for 25, 22, and 7 months after the surgery, respectively. The X-ray films showed the fracture healed at 7 months in two case, and at 12 months in one. One patient got her nail removed 25 months after the operation, feeling good 37 months after the removal.Conclusion This technique is an option to manage the hypertrophic and oligotrophic fracture nonunion of the femur after dynamization of IMN. It is mini-invasive to the nonunion site, easy to practice and allows early rehabilitation.

关 键 词：股骨骨折 骨折 不愈合 骨折固定术 髓内 外固定器 

分 类 号：R687.3[医药卫生—骨科学]