股骨干骨折内固定失效原因探讨

Analysis and treatment of internal fixation failure in femoral shaft fractures

目的 探讨股骨干骨折内固定失效的原因,总结预防与手术治疗的临床经验。方法 回顾自1997年所收治的股骨干骨折内固定失效16例,其中梅花针弯曲2例,钢板弯曲1例,钢板断裂9例,螺丝钉断裂或松动3例,钢板断裂同时伴螺丝钉松动1例。再次手术均采用自体髂骨植骨,带锁髓内钉固定11例,加压钢板固定3例,单臂外固定支架固定2例。结果 随访全部病例,骨折均愈合,膝关节功能除2例遗留屈曲未达90°以外,其余均恢复正常,无断钉及感染等并发症发生。结论 股骨干骨折内固定失效的因素是多方面的,每一个环节都应引起重视,带锁髓内钉是治疗股骨干骨折内固定失效的首选内固定方法。

Objective To realize internal fixation failure reasons after femoral shaft fractures treatment and to suitable operative treatment. Methods Sixteen patients with internal fixation failures were followed up since 1997, there were two cases with common intramedullary nail bended and one case with plate bended and nine cases with plate fracture and three cases with screw broken or losing. One with plate fracture and screw losing. All patients accepted second surgery with auto - lilac grafting and eleven cases fixed by interlocking nail and three cases by compression plates and tow cases by external fixator. Results All fractures were healed. Knee functions recovered except two cases with the maximum flexion less than 90° . There were complications. Conclusion There were several reasons for internal fixation failures after femoral shaft fractures and surgeons should be very careful for each procedure. Interlocking nail is the first choice for the treatment of the internal fixation failure in femoral shaft fractures.