股骨干C型骨折髓内钉加钢丝捆扎固定术后骨不连原因分析及治疗  

Analysis cause and treatment of bone nonunion after intramedullary nail and steel wire binding fixation for type C comminuted fracture of femoral shaft

作　　者：赵伟超[1] 蔡海静 侯伟娜[1] 陶忠生[1] 吕振木[1] 王延杰[1] 刘少华[1] 王秋生[1] ZHAO Wei-chao;CAI Hai-jing;HOU Wei-na;TAO Zhong-sheng;LU Zhen-mu;WANG Yan-jie;LIU Shao-hua;WANG Qiu-sheng(Dept of Hand and Foot Surgery,the 252nd Hospital of PLA,Baoding,Hebei 071000, China)

机构地区：[1]中国人民解放军第252医院手足外科,河北保定071000 [2]中国人民解放军第252医院麻醉科,河北保定071000

出　　处：《临床骨科杂志》2019年第6期738-741,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨股骨干C型粉碎性骨折交锁髓内钉加钢丝捆扎固定术后骨不连的原因,并提出防治措施。方法对21例股骨干C型粉碎性骨折交锁髓内钉加钢丝捆扎固定术后骨不连患者采用交锁髓内钉及钢丝取出,锁定钢板(LCP)加植骨(6例)和更换髓内钉加植骨(15例)治疗。结果患者均获得随访,时间9~20(15.2±3.0)个月。6例LCP治疗的患者均获得骨性愈合,愈合时间6~11(6.9±0.8)个月;未发现螺钉及钢板松动、断裂及感染等并发症;末次随访时,ASAMI评分系统中骨评价结果优良率为5/6,关节功能评价结果优良率为5/6。15例交锁髓内钉治疗的患者均获得骨性愈合,愈合时间6~13(6.7±0.5)个月;术后无感染及内固定松动、断裂等并发症;骨评价结果优良率为14/15,关节功能评价结果优良率为13/15。结论过多剥离骨膜、钢丝捆扎造成骨折区血运严重破坏,是导致股骨干C型粉碎性骨折术后骨不连的主要原因。股骨干C型粉碎性骨折的交锁髓内钉治疗中,应尽可能采用闭合复位或骨折断端有限切开,不能一味追求骨块的解剖复位,更不主张切开后应用钢丝及丝线捆扎复位。Objective To investigate the cause of bone nonunion after open reduction and interlocking intramedullary nail and steel wire binding fixation for type C comminuted fracture of femoral shaft,and put forward the prevention and treatment measures.Methods The removel surgery of interlocking intramedullary nail and steel wire were performed in the 21 nonunion patients following type C comminuted fracture of femoral shaft,who were treated with interlocking intramedullary nail and steel wire binding fixation,of which 6 cases were treated with locking plate(LCP)and bone grafting,and 15 cases were performed with replacement of interlocking intramedullary nail and bone grafting.Results All patients were all followed up for 9~20(15.2±3.0)months.Bony union was achieved in all 6 cases of LCP fixation,with the healing period ranging from 6~11(6.9±0.8)months.There was no complications such as loosening of screw and plate,implant fracture and infection.At the last follow-up,according to bone evaluation result of ASAMI bone scoring,the excellent and good rate was 5/6,and the joint function evaluation result excellent-good rate was 5/6.Bony union was achieved in 15 cases of the interlocking intramedullary nail fixation,the healing period ranged from 6~13(6.7±0.5)months.There was no complications such as infection and implant loosening and fracture.According to bone evaluation result of ASAMI bone scoring,the excellent and good rate was 14/15,the joint function evaluation result excellent-good rate was 13/15.Conclusions Excessive stripping of periosteum and steel wire binding and severe destruction of blood in fracture area are the main causes of bone nonunion of type C comminuted fracture of femoral shaft.Closed reduction or limited incision of fracture should be used in the treatment of type C comminuted of femoral shaf fracture treated with interlocking intramedullary nail.The anatomic reduction of the bone mass is not pursued blindly,and steel wire binding is not advocated.

关 键 词：股骨骨折 骨不连 交锁髓内钉 钢丝捆扎 

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