交锁髓内钉治疗股骨胫骨骨折骨不连原因探讨

TREATMENT OF NONUNION AFTER INTERLOCKING INTRAMEDULLARY NAILS FOR FEMORAL OR TIBIAL FRACTURES

目的探讨股骨、胫骨骨折交锁髓内钉内固定后发生骨不连的原因及防治方法。方法对235例使用交锁髓内钉的股骨胫骨骨折病例进行回顾性分析,手术采用闭合、小切口或有限切开复位,用三维瞄准器锁定骨折远近端。结果235例随访189例196肢,平均随访15.2个月,股骨87例发生骨不连5例;胫骨109例发生骨不连8例。骨不连与骨折部位、手术方式、解锁时间有明显关系。结论应力遮挡和局部血供障碍是静力型交锁髓内钉所致骨不连的主要原因,术中尽量闭合复位和有限切开复位内固定及适时解锁可降低骨不连的发生。

Objective To explore treatment of nonunion after interlocking intramedullary nails for femoral or tibial fractures and prevention. Methods 235cases of femoral or tibial fractures treated with interlocking intramedullary nails ware reviewed. The diaplasis of the fracture was close or open with only a little incision, and the two sides of the tracture were locked with a tris - dimension aim implement. Results 189cases （196limbs） were followed up （ averaged 15.2 months）. 5 cases occurred nonunion in 87 cases of femoral fracture and 8 cases occurred nonunion in 109 cases of tibal fractures. The nonunion had a positive correlation with fractural part, operation method and unlocking time. Conclusion Nonunion is a result of stress shielding and blood deficiency. The application of closed reduction, limited internal fixation and unlocking time can reduce the nonunion.