股骨干骨折内固定物失效的流行病学研究

Epidemiological Investigation on Failure in Internal Fixation for Femoral Shaft Facture

目的总结股骨干骨折内固定失效的流行病学特征,为其预防提供临床资料,从而避免或减少其失效的发生。方法对190例股骨干骨折内固定失效的病例进行问卷调查,根据年龄、性别、骨折部位及类型、治疗方式、失效时间等综合分析该群体的流行病学特征。结果好发年龄以20～50岁为主,平均27．5岁。好发部位以股骨中下1/3为主,类型以粉碎性骨折为主。失效时间大多在术后3～6个月。失效类型以钢板、髓内针弯曲、折断及松动为主,钢丝及螺钉以松动为主,而医源性因素仍是内固定失效的主要原因,术后康复失控是其重要原因。结论失效原因较复杂且相互存在,互相影响,尤其是在经济相对不发达地区失效的发病率仍然较高,社会学后果严重,只有熟悉股骨干骨折的解剖及生物力学特征,正确的治疗程序,绝大多数是可以避免的。

Objective To analyze epidemiological characteristics of the failure in the internal fixation for femoral shaft fracture, to provide the clinical data for its prevention and to avoid or reduce its occurrence of failure. Methods One hundred and ninty patients with the failure in the internal fixation for the femoral shaft fracture coming to our hospital for consultation received the questionnaire survey. The common plate was used in 63 cases, the compression plate in 80 cases, the common intramedullary nail in 29 cases, the interlock intramedullary nail in 8 cases and other fixation in 10 cases. The epidemiological characteristics were analyzed for this population according to the age, the sex, the site and type of the fractures, the treatment method and the failure time. Results The age for the most likely occurrence of the fracture ranged from 20 to 50 years old with the average age at 27.5 years old. The distal one third of the femoral shaft was most likely to be affected. The comminuted fracture dominated in the fractures. The failure time ranged from 3 months to 6 months postoperativelyFor the failure types, bending, fracturing and loosening occurred mainly for the steel plate and the intramedullary nails while loosening occurred mainly for the steel wires and screws. The iatrogenic factors dominated in the internal fixation while that the postoperative rehabilitation was out of control was the important reason. Conclusion Failure factors are complicated and interactive. The failure rate of the internal fixation for the femoral shaft fracture is still very high in the economically less developed area, which has results in a very serious sociological problem. Most of the failures can be prevented if the anatomy and the biomechanical characteristics of the femoral shaft fracture as well as the fight treatment procedures are well known.