股骨干骨折后不愈合的治疗

Treatment of nonunion after femoral fracture

目的:探讨股骨骨折术后不愈合的治疗方法.方法:对53例股骨骨折不愈合的患者采用LC-DCP或交锁髓内钉固定加断端骨痂回植或自体髂骨植骨,并结合早期功能锻炼.结果:本组随访6～48个月,平均21个月,骨折愈合时间4～11个月,平均6.7个月,52例股骨干骨折不愈合病例均愈合,疗效标准按kolmert功能评定,优良50例(96.2%)一般2例(3.8%).6周X线片见骨痂明显生长,活动时骨折端疼痛明显减轻,3～4个月后纵向叩击痛消失,可扶拐下地负重行走,复查X线片示,骨痂通过骨折线,6～8个月X线片示骨折完全愈合,膝关节屈曲超120°,伸直均超过0°,无内固定物断裂、松动.结论:LC、DCP或交锁髓内钉内固定加骨折端骨痂回植术或自体髂骨植骨术是治疗股骨骨折不愈合的有效方法.

Objective To discuss the treatment of nonunion after femoral fracture. Methods Fiftythree cases were treated with LC-DCP or interlocking intramedullary nail fixation plus reimplantation of osteotylus at the fracture site or autologous bone grafting, combining with functional exercises in the early periods. Results All cases were followed up for 21 months and the fracture was united from 4 to 11 months after operation. The evaluation of the results by Kolmere＇s Functional Rating Scale revealed good and excellent in 50 case（96.2%） and fair in two（3.8%）. The osteotylus growth was obviously 6 weeks later while moving the point in the fracture site decreased and become longitudinal 3～4 months later. The knock pain disappeared and the patients could move with weigh-bearing. As shown on X-ray film, osteotylus passed through the fracture line after 6 to 8 months, the complete union of the fracture was seen on the X-ray film. The knee joint flexion exceeded 120°and extension more than 0°, without fixation rupture and relaxation. Conclusion LC-DCP or interlocking intramedully nail fixation plus reimplantation of osteotylus at the fracture site or autologous bone grafting are the effective methods to treat nonunion after femoral fracture.