取出内固定后再骨折34例临床分析

Clinical analysis of the re-fractured after inner fixture removed in34cases

目的:探讨骨折内固定后再骨折的原因、治疗方法和预防措施。方法:1996～2002年对平均年龄31.5岁的34例患者进行保守治疗或手术治疗。其中包括股骨干骨折14例,股骨旋转截骨术后4例,胫骨骨折4例,指骨骨折4例,髌骨骨折3例,肱骨骨折3例,锁骨骨折2例。钢板固定术后23例,克氏针和(或)钢丝固定7例,髓内针固定3例。结果:14例保守治疗患者中,13例随访骨折完全愈合时间为12～24月,10例关节强直于功能位伴有肢体的肌萎缩,3例关节活动度良好,1例股骨干骨折患者出现骨不连;20例手术治疗的患者16例随访骨折完全愈合时间为10～24月,5例出现不同程度的关节僵直,1例肱骨干骨折患者出现骨不连,余关节活动良好。结论:对骨折的治疗应由对内固定力学方面的偏重转向对生物学方面的偏重,同时内固定的取出应在医生指导下进行适当的功能锻炼后。

Objective:To discuss the reasons,treatment methods and prevention measures for the re-fracture after inner fixture reˉmoved.Methods:We conducted conservative treatment and surgical treatment for34patients with average age of31.5years from1996to2002.Among them,including14cases of thighbone fracture,4cases of thighbone received the rotate bone cut operation,4cases of tibia fracture,3cases of kneecap fracture,3cases of humerus fracture,2cases of collarbone fracture.23cases of the fracture fixed by steel sheet,7cases of the fracture fixed by Ke's Needle and(or)steel wire,3cases of the fracture fixed by needle within marrow.Results:Out of the14patients received the conservative treatment,13cases whose complete fracture concrescence time is12～24months,10cases whose joints are stiff in the functional place and together with the limbs muscle atrophy,3cases whose movement of the joint is in a good condition,1case of the patient whose fractured thighbone could not be connected;out of the20patients received the surgical treatment,16cases whose complete fracture concrescence time is10～24months,5cases who have joint stiffness to different extents,1case whose fractured humerus could no be connected,the movement of the other joints is in a good condition.Conclusion:For treatment of the fracture,we should change the focus from inner fixing mechanics to biology,meanwhile removal of the inner fixture should be conducted after the patient effected the proper functional excises under the instructions of doctors,it is no good to remove it too early.