关节镜下逆行交锁髓内钉治疗股骨远端骨折延迟愈合和不愈合

Use of a retrograde intramedullary interlocking nail for the treatment of distal femoral non-union and delayed union through arthroscopy

目的介绍关节镜下逆行交锁髓内钉治疗股骨远端骨折延迟愈合和不愈合的方法,并评价其效果.方法2000年2月-2003年9月,对13例股骨远端骨折延迟愈合和不愈合的患者(骨折不愈合11例,延迟愈合2例)采用关节镜下逆行交锁髓内钉治疗.男9例,女4例;年龄22～64岁,平均42.4岁.13例患者全部采用扩髓和骨移植,并同时行膝关节粘连松解术.采用X线检查及膝关节KSS评分对结果进行评价.结果随访8～22个月,平均14.5个月,所有病例均骨性愈合,平均愈合时间为6.5个月,随访时膝关节平均活动度为98°,较术前改善42°;按膝关节KSS评分为92分,优7例,良3例,膝关节功能平均评分90.2分.结论使用关节镜下逆行交锁髓内钉治疗股骨远端骨折延迟愈合和不愈合具有定位准确、固定可靠、创伤小等优点,结合膝关节粘连松解术,便于膝关节早期功能锻练,促进骨折愈合,并能改善膝关节活动度和功能.

Objective: To introduce the method of treatment for non-union and delayed union in distal femur using of a retrograde intramedullary interlocking nail through arthroscopy (RIN). Methods: Between Feb 2000 and Feb 2003, 13 cases of non-union and delayed union of distal femur were treated with RIN through arthroscopy. There were 9 males and 4 females, the average age of the patients was 42.4 years (range 22 to 64 years). Reaming and bone graft was done in 13 cases, while all patients received knee adhesion release operation. The X-ray examination and KSS knee functional score were used to evaluate the results. Results: The average duration of follow-up was 14.5 months. All patients achieved solid bone union at an average of 6.5 months. A ccording to the KSS rating system, the average rang of motion (ROM) was 98 degrees, increased by 42 degrees compared with the preoperation ROM. The average knee score was 92 points. The excellent result was obtained in 9 cases, good in 4 cases. The average knee function score was 90.2 points. Conclusions: Use of a retrograde intramedullary interlocking nail for the treatment of distal femoral non-union and delayed union through arthroscopy is of benefit for early function exercises, which is less surgical exprure and solid fixation. Connected reaming technique with knee joint adhesion release should be considered in order to enhance the bone healing and the improvement of knee ROM and function.