侧方钢板联合植骨治疗股骨干骨折髓内钉固定术后不愈合17例  

17 Cases Study on Lateral Plate Combined with Bone Graft on the Treatment of Postoperative Nonunion after Intramedullary Nail Fixation of Femoral Stem Fractures

作　　者：杨楷文 何思远 罗亮 向飞帆 梁杰 叶俊武 顾浩 阳运康 YANG Kaiwen;HE Siyuan;LUO Liang;XIANG Feifan;LIANG Jie;YE Junwu;GU Hao;YANG Yunkang(Department of Bone Surgery,Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan China;Chongqing Key Laboratory of Ophthalmology,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]西南医科大学附属医院骨与关节外科,四川泸州646000 [2]重庆医科大学附属第一医院眼科学重庆市重点实验室

出　　处：《中国中医骨伤科杂志》2022年第7期65-69,共5页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：泸县人民政府与西南医科大学联合课题(2020LXXNYKD-03)。

摘　　要：目的:探讨采用侧方钢板联合植骨治疗股骨干骨折术后不愈合的临床疗效。方法:回顾性分析2014年1月至2019年8月收治的17例股骨干骨折内固定术后不愈合的患者,根据骨折类型分为肥大性骨折不愈合13例,萎缩性骨折不愈合4例。其中男12例,女5例;年龄为23~67岁,平均为(39.94±11.68)岁。治疗前、术后1个月、3个月、6个月及末次随访分别采用Lysholm评分、膝关节运动范围(ROM)、疼痛数字评分法(NRS)和Tohner-Wrnch评分标准来评价膝关节功能和骨折愈合情况,并进行统计学分析。结果:术后患者切口均Ⅰ期愈合,无早期并发症发生。17例患者均获得随访,随访时间为12~28个月,平均为(19.71±4.71)个月。X线片提示均骨性愈合,平均愈合时间为(5.48±0.51)个月,无骨折断端移位、内固定物断裂或松动等严重并发症,末次随访Lysholm评分为(94.29±2.47)分,膝关节运动范围为110°~130°,NRS疼痛分级为0级,Tohner-Wrnch评分优良率为94.12%。结论:采用侧方钢板联合自体骨移植治疗股骨干骨折不愈合疗效满意,手术时间短,术中出血少,愈合良好,术后可早期进行功能锻炼。Objective:To investigate the clinical efficacy of lateral steel plate combined with bone grafting on the treatment of nonunion of femoral shaft fracture after operation.Methods:A retrospective analysis of 17 patients with nonunion after internal fixation of femoral shaft fractures from January 2014 to August 2019 were performed,including 13 cases of hypertrophic fracture nonunion and 4 cases of atrophic fracture nonunion according to fracture type,of which 12 cases were male and 5 cases were female,aged from 23 to 67 years old,with(39.94±11.68)years old on average.The Lysholm scores,knee range of motion(ROM),numerical pain rating scale(NRS)and Tohner-Wrnch scale were used to evaluate knee functions before treatment,at 1 month,3 months,6 months after operation and at the final follow-up respectively,and results were statistically analyzed.Results:All incisions achieved primary healing with no early postoperative complication such as infection.All cases were followed up 12 to 28 months,with(19.71±4.71)months on average.X-ray showed that all fractures had bony union,with(5.48±0.51)months on average,and there were no serious complications such as displacement of broken ends,breakage or loosening of internal fixators.The Lysholm knee scores and NRS scorse at final follow-up were 94.29±2.47 and 0 respectively;ROM at final follow-up was ranging from 110°to 130°;the excellent rate of Tohner-Wrnch score was 94.12%.Conclusion:The operative treatment of lateral plate combined with bone graft has satisfactory curative efficacy fairly in postoperative nonunion of femoral stem fractures,with short operation time,low intraoperative bleeding,good healing,and early functional exercise after surgery.

关 键 词：髓内钉固定 骨折不愈合 侧方钢板 植骨 

分 类 号：R683.42[医药卫生—骨科学]