带锁髓内钉治疗股骨干骨折失败原因分析及其对策

An analysis of failure factors in treatment of femoral shaft fracture with interlocking intramedullary nailing

目的探讨带锁髓内钉治疗股骨干骨折失败的原因及其预防措施。方法1999年4月至2002年9月采用带锁髓内钉治疗股骨干骨折患者213例,其中失败18例。回顾性分析这18例患者的临床资料,并对其进行分类。结果18例患者中,按失败原因可分为断钉3例,其中主钉断裂2例,主钉合并远端锁钉断裂1例;远端锁钉退出7例;近端锁钉退出3例;膝关节纤维性强直3例;迟发感染2例。手术技术、手术适应证选择、康复锻炼的规范性、髓内钉的强度及合适与否是导致失败的相关原因。结论应用带锁髓内钉治疗股骨干骨折应掌握好适应证,强调术前准备充分,术中操作规范,术后锻炼应循序渐进,避免过早负重,是减少或防止内固定失效的重要措施。

Objective To analyze the failure factors treating femoral shaft fracture with interlocking intramedullary nailing, and to offer the measures for prevention. Methods From April 1999 to September 2002, among the 213 cases of femoral shaft fracture treated by interlocking intramedullary nailing, 18 were failure. The data of these cases were analyzed. Results The failure cases were divided into 6 types： 3 cases with nail break-down, 7 with distal screw backing out, 3 with proximal screw backing out, 3 with fibrous ankylosis of knee, 2 with late infection. Failure relative factors were regarded to operation technique, incorrect rehabilitation choice of operative indication, quality of interlocking intramedullary nailing. Conclusions An appropriate indication should be chosen as using interlocking intramedullary nailing for femoral shaft fracture. The skills should be mastered well. The suitable materials should be chosen carefully. And the rehabilitation exercises should be directed properly. All these are important measures for prevention.