股骨干骨折内固定术后骨不连外科治疗  

Surgical treatment of nonunion of femoral shaft fracture after internal fixation

作　　者：杰恩斯.达尼牙尔 艾克拜尔.尤努斯 陈江涛[2] 宋兴华[2] 田征[2] 王翀[2] 

机构地区：[1]新疆吉木萨尔县人民医院骨科,新疆吉木萨尔县831700 [2]新疆医科大学第一附属医院骨科中心,乌鲁木齐830054

出　　处：《中华实用诊断与治疗杂志》2015年第2期152-154,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81160218)

摘　　要：目的探讨股骨干骨折内固定术后骨不连的手术治疗方法与效果。方法 18例股骨干骨折内固定术后骨不连患者,于手术取出原内固定后,采用交锁髓内针固定12例,动力加压钢板固定并辅以自体骼骨植骨6例。结果术后1例失访,17例获随访14~26个月,骨性愈合时间4~11个月;术后12个月,膝关节活动度为0~100°,疗效优6例,良8例,可3例,优良率为82.3%;1例术后4个月远端2枚锁钉断裂,同法更换髓内针后11个月骨折愈合;1例术后原切口感染,抗生素治疗2周切口愈合;1例术后1a植骨处有顽固性疼痛。结论骨缺损尤其是压力侧骨缺损是导致股骨干骨折内固定术后骨不连的主要原因;采用含骨皮质的髂骨作为植入骨治疗骨不连疗效确切。Objective To explore the surgical treatment and its therapeutic effect on bone nonunion of femoral shaft fracture after internal fixation.Methods Eighteen patients with bone nonunion of femoral shaft fracture after internal fixation received interlocking intramedullary pins fixation in 12 patients and dynamic compression plate fixation supplemented by autologous skeletons bone graft in 6patients after removing the original internal fixation.Results One patient was lost follow-up and 17 patients were followed up for 14 to 26months.Osseous healing time was from 4to 11 months.The knee joint activity was from 0to 100°12 months after operation.The surgical result was excellent in 6patients,good in 8and general in 3,with the excellent and good rate of 82.3%.One patient was replaced intramedullary pin due to two distal locking nails fracture after 4months,and the fracture was healed 11 months later.Incision infection occurred in one patient and healed after antibiotics therapy for 2weeks.Intractable pain occurred in bone graft position in one patient in one year after operation.Conclusion Femoral fractures nonunion after internal fixation is mainly caused by bone defect,especially in the pressure side.Cortical ilium as implants is effective for bone nonunion.

关 键 词：股骨干骨折 骨不连 交锁髓内针 

分 类 号：R687.3[医药卫生—骨科学]