两种翻修方法治疗股骨干骨折术后内固定失效的疗效比较  

The efficacy comparison of two kinds of revision surgery after failed plating for femoral shaft fractures

作　　者：黄尊贤 林达生[1] 余爱玉[1] 章鹏[1] 练克俭[1] 

机构地区：[1]解放军第175医院骨科,福建漳州363000

出　　处：《临床骨科杂志》2016年第3期340-343,共4页Journal of Clinical Orthopaedics

摘　　要：目的比较钢板结合异体骨板（PWBP）固定与交锁髓内钉（IIN）固定治疗股骨干骨折术后内固定失效的临床疗效。方法38例股骨干骨折术后内固定失效的患者按照翻修方法分为PWBP组（18例）和IIN组（20例）。比较两组的手术时间、术中出血量、骨折愈合时间、膝关节HSS评分及并发症。结果患者均获得随访，时间12-18个月。两组的手术时间、术中出血量差异均无统计学意义（P〉0．05）。骨折愈合时间：PWBP组13～18（16．8±2．7）周，IIN组10～18（14．3±3．8）周，差异有统计学意义（P〈0．05）。术后膝关节HSS评分两组均较术前明显改善（P〈0．05），两组间差异无统计学意义（P〉0．05）。PWBP组1例出现股四头肌粘连，行松解术后持续CPM训练，疗效满意；IIN组2例出现骨不连，均为术前存在较大骨缺损者，改行PWBP后骨折获得愈合。结论PWBP与IIN治疗股骨干骨折术后内固定失效均能起到满意疗效。IIN固定在骨折愈合时间上具有一定优势，但对于存在较大骨缺损者有术后发生骨不连的风险。Objective To compare the efficacy of plate combined with allograft bone plate（PWBP） and interlocking intramedullary nails （IIN） to treat failed plating for femoral shaft fractures. Methods Thirty-eight patients who failed plating for femoral shaft fractures were divided into two groups according to their revision surgery, 18 patients were treated with PWBP, while the other 20 patients were treated with IIN. The operation time, volume of bleeding during operation, fracture union time, complications and the HSS scores between two groups were compared. Results All patients were followed up for 12 - 18 months. There were no significant differences between two groups in operation time and volume of bleeding（ P 〉 0. 05 ）. There was significant difference between two groups in fracture healing time （P 〈 0. 05） ,which was 13 - 18 （ 16. 8 ± 2. 7） weeks in PWBP group and 10- 18 （ 14. 3± 3.8 ） weeks in IIN group. The HSS scores of two groups in last follow-up had significantly improvement compared with preoperation in both groups（P 〈0. 05） , compared with each other, there was no significant difference （P 〉0. 05）. One patient in PWBP group occurred quadrieeps adhesion, after the release surgery and continuous CPM training, the patient obtained a satisfactory outcome. Two patients with massive bone defect in IIN group occurred nonunion, and both of them got fracture healing after reoperation by PWBP. Conclusions Both of PWBP and IIN for treatment of failed plating for femoral shaft fractures can obtain satisfactory effects. IIN can get shorter fracture healing time. However, for those cases with massive bone defect before operation, treating with IIN have risk of nonunion.

关 键 词：股骨干骨折 内固定失效 异体骨板 交锁髓内钉 

分 类 号：R687.3[医药卫生—骨科学] R683.42[医药卫生—外科学]